To investigate the ultrasonographic features of uterine leiomyosarcoma and analyze the causes of misdiagnosis.

Preoperative clinical imaging data of 16 patients with uterine leiomyosarcoma confirmed by surgery and pathology at the First Medical Center of PLA General Hospital from June 2013 to December 2018 were selected for analysis.

Preoperative ultrasound showed multiple intrauterine lesions in six cases and single lesions in nine cases. Among the 16 cases included, 12 were intramural, 3 were submucosal, and 1 was cervical. The morphology of lesions was regular in 9 cases and irregular in 7 cases. The boundary was clear in 6 cases and unclear in 10 cases. Inhomogeneous hyperechogenicity was found in 9 cases, mixed echogenicity found in 4 (with liquefactive necrotic areas), and hypoechogenicity in 3. In 9 of the 16 cases, there was no significant attenuation in the inner or submucosal posterior lesions, and the posterior echo was slightly enhanced. When the shape of the lesion was irregular, there were necrotic areas in the lesion, which showed mixed echogenic cystic and solid changes, and the serosal layer was involved in the extrauterine expansion growth. At the late stage, metastases of adjacent iliac vessels lymph nodes and the formation of tumor thrombolytic in the pelvic and abdominal veins were observed.

Utrasound diagnosis of uterine leiomyosarcoma has some limitations, but for a single lesion in the myometrium, it is slightly hyperechoic or has heterogeneous echo, with unclear boundary, uneven internal echo, rich blood supply, and soft lesion texture. It is necessary to be on alert for possible malignant lesions when the probe is deformed under pressure, and in this case, confirmation by pathological diagnosis is recommended.