Leiomyosarcoma differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Leiomyosarcoma must be differentiated from Peptic ulcer, Stomach cancer, Uterine cancer.
Differentiating Leiomyosarcoma from other Diseases
The table below summarizes the findings that differentiate Leiomyosarcoma from other conditions that may cause similar signs and symptoms.[1][2][3]
| Disease | Clinical Features | Physical Examination | Diagnosis |
| Gastric cancer | Abdominal pain, Weight loss, Heartburn, Belching,Nausea,Vomiting,Weight loss,Loss of Appetite,Dysphagia,Hemetemesis,Melena | Pallor,Jaundice,Acanthosis Nigrans,Leasr-Trelat signs,Left supraclavicular Lypmph adenopathy,Abdominal mass and distension,Splenomegaly,Ascites,Hepattomegaly. | Esophagogastroduodenoscopy |
| Endometrial Cancer | Abnormal Vaginal bleeding,Post coital bleeding,Fatigue,weight loss,Pelvic pain and dysparunia | Tachycardia,Tachypnea,Pallor,Jaundice,Vaginal bleeding, Enlarged uterus,Pedal Edema,Hepatomegaly,Lymphadenopathy,Decreased breath sounds(depending upon the staging of the cancer) | CBC,LFT,CA-125,CA,PFT,xray chest,CT,MRI,Ultrasound, Endometrial Curettage,D and C,Endometrial Biopsy and Tru test. |
| Peptic Ulcer Disease | Episodic epigastric pain,fever,melena,hematemesis | Hypotension if perforation,Abdominal guarding and rigidity,normal bowel sounds | Ascites fluid analysis for LDH,glucose,and protein,chest xray if perforation,Upper GI Endoscopy,Serum gastrin level,Secretin stimulation test,Biopsy |
| Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms | Physical examination | ||||||||||||||
| Lab Findings | Imaging | Histology | |||||||||||||
| Symptom 1 | Symptom 2 | Symptom 3 | Physical exam 1 | Physical exam 2 | Physical exam 3 | Lab 1 | Lab 2 | Lab 3 | Imaging 1 | Imaging 2 | Imaging 3 | ||||
| Peptic Ulcer Disease | Episodic Epigastric pain | Melena | Hematemesis | Epigastric tenderness | Abdominal guarding and rigidity if perforated | Normal Bowel Sounds | CBC Suggestive of Anemia | Serum Gastrin Level or Secretin stimulation test to rule out Zollinger Ellison syndrome | Urea breath test or Stool antigen done for Helicobacter pylori | Chest xray suggestive of pneumoperitoneum if perforated | CT scan suggestive of pneumoperitoneumif perforated peptic ulcer | Barium radiography,although infrequently used,suggestive of an ulcer niche is generally round or oval and may be surrounded by a smooth mound of edema | Upper GI Endoscopy | - | |
| Gastric Adenocarcinoma | Abdominal pain | Dysphagia | Hematemesis or Melena | Abdominal mass/Distension | Pallor | Left supraclavicular lyphadenopathy | CBC suggestive of anemia | LFT suggestive of Jaundice is seen in the pre terminal stages of metastatic disease | Ascitic fluid analysis in case of peritoneal carcinomatosis | Barium studies can identify both malignant gastric ulcers and infiltrating lesions and some early gastric cancers but false negative can be as high as 50% | - | - | Esophagogastrduodenoscopy | Systematic manifestation of gastric cancer are Acanthosis Nigrans and Leasr-trelat but are not specific of gastric cancer | |
| Endometrial Cancer | Abnormal Vaginal bleeding or post coital bleeding | Pelvic pain | Dysparunia | Vaginal Bleeding | Enlarged uterus | Lymphadenopathy | CBC and Clotting studies to r/o anemia and coagulopathy | Urine or serum Beta HCG to r/o pregnancy | - | Thickened endometrial line on ultrasound. | Thickened endometrial line on CT | Thickened endometrial line on MRI | Biopsy under hysteroscopic guidance | - | |
| Symptom 1 | Symptom 2 | Symptom 3 | Physical exam 1 | Physical exam 2 | Physical exam 3 | Lab 1 | Lab 2 | Lab 3 | Imaging 1 | Imaging 2 | Imaging 3 | Histopathology | Gold standard | Additional findings | |
| Differential Diagnosis 4 | |||||||||||||||
| Differential Diagnosis 5 | |||||||||||||||
| Differential Diagnosis 6 | |||||||||||||||
References
- ↑ Cotton PB, Shorvon PJ (1984) Analysis of endoscopy and radiography in the diagnosis, follow-up and treatment of peptic ulcer disease. Clin Gastroenterol 13 (2):383-403. PMID: 6378443
- ↑ Wanebo HJ, Kennedy BJ, Chmiel J, Steele G, Winchester D, Osteen R (1993) Cancer of the stomach. A patient care study by the American College of Surgeons. Ann Surg 218 (5):583-92. PMID: 8239772
- ↑ Kimura T, Kamiura S, Yamamoto T, Seino-Noda H, Ohira H, Saji F (2004) Abnormal uterine bleeding and prognosis of endometrial cancer. Int J Gynaecol Obstet 85 (2):145-50. DOI:10.1016/j.ijgo.2003.12.001 PMID: 15099776