Literature review of outcomes and prevalence and case report of leiomyosarcomas and non-typical uterine smooth muscle leiomyoma tumors treated with uterine artery embolization

ObjectiveTo describe the early and late outcomes of uterine smooth muscle tumors that are either malignant or have the potential for recurrence (MRUSMTs) after uterine artery embolization (UAE).DesignLiterature review of MRUSMTs in case reports and in studies on patient outcome after UAE and reports of one case of leiomyosarcoma (LMS) and 2 cases of bizarre leiomyoma (BL) after UAE.SettingUniversity hospital.Intervention(s)Main outcome measure(s) and clinical outcome of UAE and prevalence of MRUSMT.Result(s)In the review of clinical trials, six cases of sarcomas were reported after UAE treatment in 8084 procedures. One of the six sarcoma cases and one case of intravenous leiomyomatosis occurred more than two years after the UAE.Thirteen cases of LMS, two cases of BL and no cases of MRUSMTs after UAE were identified in the published case reports. Six of the thirteen patients with sarcomas exhibited a good initial clinical response, but their symptoms relapsed after six months. UAE had a failed outcome in the two BL cases.Conclusion(s)MRUSMTs are rarely treated using UAE; late malignant transformation is infrequent but may be underreported. UAE treatment of leiomyosarcomas does not seem to spread the disease, but this approach may impair prognosis by delaying diagnosis. Tumors with low malignant potential may initially exhibit volume reduction and a good clinical response, but these tumors may exhibit persistent enhancement with contrast-enhanced magnetic resonance imaging (MRI). Special attention is required in cases with or without a limited response to UAE.