Uterine leiomyosarcoma is a rare malignancy and is difficult to diagnose preoperatively. In this case series, we retrospectively reassessed ultrasound findings of 18 leiomyosarcoma cases and proposed the diagnostic workup. We are select seven ultrasound features and found irregular tumor border in 100%, loss of normal myometrium >25% in 61.11% (12 cases), loss of typical benign leiomyoma feature >50% in 77.78%, necrosis in 85.7% (16 cases), and cystic degeneration in 83.3% (15 cases). Circumferential vascularity was absent or minimal in 66.7% of cases, whereas intralesional vascularity with minimal or moderate intralesional vascularity was seen in 12 (66.7%) cases. Diagnosis of suspected uterine leiomyosarcoma requires five out of these seven features present, four gray-scale and one color Doppler ultrasound.
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