Differential Diagnosis for Heterogeneous Lesion with Vascularity in the Uterus

Single Most Likely Diagnosis

• Uterine Leiomyosarcoma: This is a rare but aggressive type of cancer that originates from the smooth muscle cells of the uterus. The presence of a heterogeneous lesion with vascularity is highly suggestive of a malignant process, and leiomyosarcoma is a key consideration given its potential for rapid growth and vascularization.

Other Likely Diagnoses

• Uterine Leiomyoma (Fibroid) with Degeneration: While most fibroids are benign, they can undergo degeneration, which may result in a heterogeneous appearance on imaging. The presence of vascularity could be indicative of a fibroid that is still actively growing.
• Adenomyosis: This condition involves the growth of endometrial tissue into the uterine wall, which can lead to a heterogeneous appearance on imaging due to the mixture of endometrial and myometrial tissue. Vascularity may be increased due to the hormonal responsiveness of the endometrial tissue.
• Uterine Arteriovenous Malformation (AVM): AVMs are abnormal connections between arteries and veins, which can occur in the uterus. They are characterized by their high vascularity and can present as heterogeneous lesions due to the variety of vascular structures involved.

Do Not Miss Diagnoses

• Uterine Metastasis: Metastatic disease to the uterus from other primary cancers (e.g., breast, colon, or ovarian cancer) can present as heterogeneous lesions with increased vascularity. Missing this diagnosis could lead to a significant delay in appropriate treatment.
• Gestational Trophoblastic Disease (GTD): GTD includes a range of diseases from hydatidiform mole to choriocarcinoma. These conditions can present with highly vascular and heterogeneous uterine lesions. Given their potential for aggressive behavior and metastasis, they are critical not to miss.

Rare Diagnoses

• Uterine Hemangioma: A benign vascular tumor of the uterus, which could present as a heterogeneous and vascular lesion. However, uterine hemangiomas are exceedingly rare.
• Uterine Lymphangioma: A rare benign tumor consisting of lymphatic vessels, which might appear as a heterogeneous lesion with increased vascularity due to its lymphatic nature.
• Kaposi's Sarcoma: A type of cancer that can involve the uterus, particularly in immunocompromised patients. It is characterized by its vascular nature and could present as a heterogeneous lesion.