I have contacted many patients with fibroids in the clinic and am very concerned about the problem of fibroid malignancy, so I thought I’d write a scientific article to explain it. First of all, it is important to emphasize that fibroids are usually not malignant. Malignant diseases of the uterus include endometrial carcinoma, uterine sarcoma, endometrial mesenchymal sarcoma and other pathological types, and rare ones include lymphoma, intravascular smooth muscle tumor, etc. These are all pathological diagnoses, and a surgeon, before sending the resected specimen for pathological examination, sometimes it is difficult to identify benign and malignant. Therefore, uterine malignancy is a pathological diagnosis. The main clinical distinction that needs to be made from fibroids is uterine sarcoma. Endometrial cancer and interstitial endometrial sarcoma usually have irregular bleeding, and preoperative scraping pathology can often obtain the diagnosis in advance. In clinical practice, uterine fibroids are a common disease. According to statistics, 10-20% of the population has fibroids, and in foreign surveys, the incidence of fibroids in black people around 50 years old is even as high as 70%. This shows that uterine fibroids are a common disease. In previous textbooks, it was written that the incidence of sarcomatous transformation of uterine fibroids was at 0.5%, but the source can no longer be found, and in my clinical experience, the rate is probably much lower than that. According to population statistics in the United States, the incidence of uterine sarcoma is 17.1 per 1 million people, and if we compare it to fibroids at 100,000 per 1 million (at a rate of 10%), then the ratio of fibroids to sarcomas in the population is about 6000:1. The problem. So when should we consider the presence of uterine sarcoma in the clinical process? First of all, uterine sarcoma usually occurs in older patients, with the average age in the past statistically at 48 years, while uterine fibroids occur in relatively younger patients, but of course the incidence is higher in older patients. Secondly, many people ask whether the fast growth of fibroids means malignancy. To answer this question, it is necessary to understand the growth pattern of fibroids in general. Statistically, the average growth of fibroids is about 1.2cm per year, which means that some patients may not grow at all in a year, while some patients grow much faster. The speed of growth does not absolutely indicate whether the fibroids are malignant or not. So now, is there a way we can find out if a fibroid is a uterine sarcoma? As a clinician, it is important to stay abreast of the world’s research advances in this field. In 2002, researchers from Japan did an industry impacting study, published in the International Journal of Gynecologic Oncology. They used the technique of enhanced delayed visualization MRI combined with serum lactate dehydrogenase (LDH) isoenzyme3 and found that in 10 patients with uterine sarcoma, delayed enhancement images could be observed in all 10 patients with 60-second enhanced MRI images, while in patients with benign degeneration of uterine fibroids, only 4 out of 32 cases showed delayed enhancement. 10 patients with uterine sarcoma All patients had elevated LDH and LDH isoenzyme 3. This study suggests that the combination of delayed enhancement MRI and LDH testing would be useful in differentiating benign degeneration of uterine sarcoma from fibroids. The number of this study is still small, and more data are needed to verify whether this pattern can be reproduced in a larger population, but the study is already very valuable for our clinical practice. Screening. In summary, sarcoma that needs to be differentiated from fibroids is a rare phenomenon, and LDH and enhanced delayed imaging MRI can help to differentiate benign from malignant if sarcoma is suspected.