cystic degeneration of uterine fibroid radiology

68, 28 July 2015 | SpringerPlus, Vol. 54, No. Figure 5b. (e) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. Radiology. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. Figure 7a. Figure 2a. (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. Figure 14b. 53, No. Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. Leiomyoma with ring calcification (probably a sequela of red degeneration) in a 42-year-old woman. However, they sometimes demonstrate retroperitoneal growth, usually within the broad ligament. Figure 4d. (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows complete absence of enhancement, a finding that indicates infarction. 3, Seminars in Ultrasound, CT and MRI, Vol. (Reprinted, with permission, from reference 4. 6, Gynecologic Oncology Case Reports, Vol. Axial spin-echo T2-weighted (2,000/70) (a) and gadolinium-enhanced T1-weighted (600/20) (b) MR images show a mass (arrows), which demonstrates high signal intensity on the T2-weighted image (a) and heterogeneous enhancement on the gadolinium-enhanced image (b). (c) Photograph of the cut surface of the resected lesion shows an almost entirely cystic mass with scanty solid tissue. Sagittal (TR 4,800 ms, TE 80 ms) (, The variation in size of fibroids is enormous, ranging from microscopic size (1–2 mm in diameter that are not detectable with imaging) to a quite large size (10–20 cm in diameter). T1 1, 30 August 2013 | European Radiology, Vol. Although histologically benign, these leiomyomas grow into veins, metastasize to distant organs, diffuse throughout the uterine parenchyma, or disseminate throughout the peritoneal cavity. The high signal intensity on T2-weighted images is attributed to the accumulation of fluid, and the prominent enhancement is explained by retention of contrast material within the abundant interstitial spaces (,11). The first two types may have MR imaging findings characteristic enough to allow diagnosis and are discussed in this section. Smooth muscle cells are so widely separated by abundant myxoid material that mitotic count and cellularity cannot be assessed precisely.Download as PowerPointOpen in Image Viewer. 2, 18 January 2018 | The British Journal of Radiology, Vol. This myxoid leiomyoma had a blood supply only from the fallopian tube and was considered to be a parasitic growth, although this fact was not clear at MR imaging. (a) Sagittal spin-echo T2-weighted MR image (2,000/70 [repetition time msec/echo time msec]) shows a well-demarcated mass of distinct low signal intensity with a speckled appearance. Doppler US shows fibroids’ circumferential vascularity, but some of them have great vascularization, while necrotic fibroids have an absence of flow. Macroscopically, fibroids may be singular, but more often, in the same uterus at the same time, there are multiple fibroids, very variable in size, in structural composition, and in location (Figs. Sagittal T2-weighted image (TR 4,500 ms, TE 90 ms) (, Patient with abnormal uterine bleeding and with lumbar pain. Subserosal leiomyoma with extensive cystic degeneration in a 61-year-old woman. Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Teaching File: Right Atrial Mass in a Woman with Uterine Fibroids, Bonne pratique et valeur diagnostique de l’imagerie, Ovarian cavernous haemangioma presenting as a heavily calcified adnexal mass, Embolización terapéutica de leiomiomas uterinos; casos que requirieron cirugía, Diagnosis, imaging and anatomical classification of uterine fibroids, Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids: early clinical experience, The utility of diffusion-weighted MR imaging for differentiating uterine sarcomas from benign leiomyomas, Epidemiology, Presentation, and Management of Retroperitoneal Leiomyomata: Systematic Literature Review and Case Report, Uterine Artery Embolization in Patients with Symptomatic Diffuse Leiomyomatosis of the Uterus, Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: initial results, THE ROLE OF MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF GYNECOLOGIC DISEASE, Disseminated peritoneal leiomyomatosis: magnetic resonance imaging and differential diagnosis, Postmenopausal Uterine Leiomyoma with Hemorrhagic Cystic Degeneration Mimicking Ovarian Malignancy, Calcifying uterine leiomyoma invading the urinary bladder, Torsion of a uterine leiomyoma: MRI features, Uterus-like mass: MRI appearance of a very rare entity, Isolated adenomyotic cyst associated with severe dysmenorrhea, MR Imaging of Acute Right Lower Quadrant Pain in Pregnant and Nonpregnant Patients1, Huge uterine leiomyoma with adenomyotic cysts mimicking uterine sarcoma on MR imaging, Uterine Fibroid with Calcified Rim Formation Mimicking a Fetal Head after Uterine Artery Embolization, Leiomyoma of the trachea: CT and MRI findings, MR Imaging Evaluation of Acute Abdominal Pain During Pregnancy, Use of MR Imaging for Further Evaluation of Sonographically Detected Adnexal Pathology, Magnetic resonance imaging of uterine leiomyomata, Pathologies of the uterine endometrial cavity: usual and unusual manifestations and pitfalls on magnetic resonance imaging, Apport de l’IRM dans la prise en charge des fibromes utérins, A case of invasive squamous cell carcinoma on the surface of pedunculated cervical leiomyoma presenting an exophytic cervical cancer, MRI of Right-Sided Abdominal Pain in Pregnancy, MR Imaging of Maternal Diseases of the Abdomen and Pelvis during Pregnancy and the Immediate Postpartum Period1, Pseudo-Meigs' Syndrome with Degenerative Uterine Leiomyoma in Pregnancy. Leiomyomas are by far the most common uterine tumors and the most common gynecologic tumors. The cervical canal (arrowheads) is folded into the myoma. Hyaline cystic degenerations of the uterine fibroids may be rare but not uncommon. )Download as PowerPointOpen in Image 1, 23 May 2014 | Abdominal Imaging, Vol. Unlike other types of degeneration, red degeneration usually causes systemic symptoms. Hemorrhage and necrosis are not obvious. See print version. Cystic Fibroids Degeneration Cystic degeneration is not so common type of fibroids degeneration; it affects only 4% of all fibroids … (a) Sagittal T2-weighted spin-echo MR image (2,000/70) shows a mass of intermediate signal intensity with a high-signal-intensity periphery (arrows). Figure 9a. They are living tissue, requiring oxygen and nutrients to survivie and grow, supplied by blood vessels in an around the uterus. (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. Edema is not a phenomenon of degeneration but is a common histopathologic finding, present in about 50% of leiomyomas (,1). (a, b) Sagittal spin-echo T2-weighted (2,000/70) (a) and T1-weighted (600/20) (b) MR images show a huge mass with signal intensity similar to that of fluid: high on the T2-weighted image (a) and low on the T1-weighted image (b). Fibroid degeneration typically occurs when a fibroid outgrows its vascular supply . Huge cervical leiomyoma in a 32-year-old woman. (c) Photomicrograph (original magnification, ×100; hematoxylin-eosin stain) shows hyaline degeneration throughout the lesion (*).Download as PowerPointOpen in Image Viewer. Uterine fibroid degeneration occurs when a fibroid outgrows its limited blood supply. 46, No. )Download as PowerPointOpen in Image (c) Diagram shows the relationships between the mass (M), cervical canal (*), and uterus (u).Download as PowerPointOpen in Image (c) Photograph of the cut surface of the resected lesion shows an almost entirely cystic mass with scanty solid tissue. Hemorrhage and necrosis are not obvious. Other unusual growth patterns are retroperitoneal growth and parasitic growth. Edema may change into various degrees of collagen deposition and cystic degeneration (,6). Secondary calcification occurs in hyalinized tissue in about 4% of leiomyomas (,1). Figure 8b. Intravenous leiomyomatosis in a 44-year-old woman. This myxoid leiomyoma had a blood supply only from the fallopian tube and was considered to be a parasitic growth, although this fact was not clear at MR imaging. Consistent with their benignity, leiomyomas have a “pushing” (instead of infiltrating) border and are rounded. Figure 8b. 2, 27 August 2015 | Radiology, Vol. ), Figure 9b. Leiomyoma with myxoid degeneration in a 55-year-old woman. Lipoleiomyoma in a 76-year-old woman. Figure 4e. Fibroids derive their main blood supply almost exclusively directly from branches of the arcuate (intramural) arteries. Viewer. 25, No. Figure 11a. 205, No. Leiomyoma with extensive edema in a 25-year-old woman. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. (b) Photograph of the cut surface of the resected lesion shows a white mass with a speckled appearance. The cervical canal (arrowheads) is folded into the myoma. Subserosal leiomyoma with extensive cystic degeneration in a 61-year-old woman. 2016, Journal of Evidence Based Medicine and Healthcare, Vol. It can occur in pregnancy and non-pregnant state in the reproductive age. (a, b) Sagittal spin-echo T1-weighted (600/25) (a) and T2-weighted (2,000/70) (b) MR images show a mass posterior to the uterus (U) (arrows). (e) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. Figure 10d. Cystic Degeneration of Uterine Fibroid Mimicking a Malignant Uterine Neoplasm on MRI. 6, International Journal of Gynecological Cancer, Vol. 8, American Journal of Roentgenology, Vol. Imaging. 4, 29 May 2008 | Radiation Medicine, Vol. (,,,,,,Fig 9a-,,,,,,9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan. See print version.Download as PowerPointOpen in Image See print version. Figure 6a. 1, 30 May 2013 | Japanese Journal of Radiology, Vol. 46, No. 3 In general, these areas of cystic degeneration are irregular and can appear as a combination of cystic and solid components of variable echogenicity. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. (a, b) Sagittal fast spin-echo T2-weighted (6,000/126) (a) and spin-echo T1-weighted (600/9) (b) MR images show a mass with a distinct rim of low signal intensity (arrowheads). Leiomyoma with myxoid degeneration in a 55-year-old woman. They occur in ~25% of women of reproductive age 1and are particularly common in the African population. Leiomyoma with extensive edema in a 25-year-old woman. Figure 10d. Submucosal and intramural fibroids may also cause infertility, spontaneous abortions, or premature placental abruption. See print version. Degenerative fibroids may have a complex appearance. Leiomyoma with extensive edema in a 25-year-old woman. Figure 6b. Figure 1a. 39, No. 26, No. (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/20) shows prominent enhancement of the lesion except for small foci of mucinous lakes (arrowheads). (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. 3, The Journal of Emergency Medicine, Vol. 3, Seminars in Ultrasound, CT and MRI, Vol. (a) Sagittal spin-echo T2-weighted MR image (2,000/70) shows a large mass of high signal intensity with scattered foci of low signal intensity arising from the uterus. 4, 26 September 2017 | Abdominal Radiology, Vol. However, leiomyomas vary widely in appearance and may be confused with other gynecologic malignancies. 2, 1 July 2002 | RadioGraphics, Vol. (b, c) Photomicrographs (original magnification, ×20; hematoxylin-eosin stain) show tightly packed smooth muscle cells in the central zone (b) and prominent edema with large vessels at the periphery (c). (a) Sagittal spin-echo T2-weighted MR image (2,000/70) shows a large mass of high signal intensity with scattered foci of low signal intensity arising from the uterus. 27, No. 5, Taiwanese Journal of Obstetrics and Gynecology, Vol. (d) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows nuclear atypia. (c) Diagram shows the relationships between the mass (M), cervical canal (*), and uterus (u). The signal intensity of the mass corresponds to fluid mixed with thin, interlacing tissue of intermediate signal intensity on both images. (a-c) Sagittal fast spin-echo T2-weighted (3,000/120) (a) and spin-echo T1-weighted (400/25) (b) MR images and gadolinium-enhanced spin-echo T1-weighted MR image (400/25) obtained with fat suppression (c) show a mass (arrows) with signal intensity equal to that of subcutaneous fat. The wormlike projections are accompanied by prominent signal voids (small arrowheads in a). (e) Photomicrograph (original magnification, ×20; hematoxylin-eosin stain) shows sparse smooth muscle cells (arrows) scattered within an area of extensive edema (*). 1, Nuclear Medicine Communications, Vol. Features of multiple uterine fibroids. Changes in uterine leiomyomas, such as hyaline, cystic, red and myxomatous degeneration and calcification, are considered to be a result of inadequate blood supply 2. 39, No. Convoluted, wormlike masses growing within the veins are the hallmark of intravenous leiomyomatosis (,,,,Fig 11) (,17,,18). AB - Uterine fibroids are the most common benign uterine neoplasms, occurring in 20% to 30% of women of reproductive age.  weighted images: differentiation between leiomyosarcomas and leiomyomas, Cystic degeneration of hepatic adenoma: a rare complication of hepatic adenoma, 4. Hemorrhage, necrosis, and calcification (∼4% of cases) may also be observed. (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/20) shows prominent enhancement of the lesion except for small foci of mucinous lakes (arrowheads). 36, No. Figure 14a. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. (b, c) Photomicrographs (original magnification, ×20; hematoxylin-eosin stain) show tightly packed smooth muscle cells in the central zone (b) and prominent edema with large vessels at the periphery (c). 3, The Journal of the American Association of Gynecologic Laparoscopists, Vol. (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. 27, No. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/9) show irregular areas of necrosis (arrows). The arcuate arteries course through the outer third of the myometrium and are branches of the uterine artery. Intravenous leiomyomatosis, metastasizing leiomyoma, diffuse leiomyomatosis, and peritoneal disseminated leiomyomatosis represent unusual growth patterns; other unusual growth patterns are retroperitoneal growth, parasitic growth, and the pattern that may occur in cervical leiomyoma. The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). Hemorrhage and necrosis are not obvious. Peritoneal disseminated leiomyomatosis is initiated or promoted by hormonal factors; the leiomyomas regress after hormonal stimulation is stopped. Figure 4b. 9, Journal of Magnetic Resonance Imaging, Vol. 5, Best Practice & Research Clinical Obstetrics & Gynaecology, Vol. Viewer. These arteries have a diameter of 500–1,000 μm in most cases; instead, the arcuate and radial arteries, the spiral arterioles, and the utero-ovarian anastomosis have usually a diameter less than 500 μm. With extensive edema, the entire lesion has high signal intensity on T2-weighted images and demonstrates marked enhancement (,11) (,,,,,,Fig 6). Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). (a, b) Sagittal fast spin-echo T2-weighted MR images (6,000/135) show an ill-defined, subserosal mass of low signal intensity (arrows in a) with multiple wormlike projections that extensively involve the myometrium, parametrium, adnexa, and gonadal veins (large arrowheads in a, arrowheads in b). ), Figure 2b. (c) Diagram shows the relationships between the mass (M), cervical canal (*), and uterus (u). Leiomyoma with ring calcification (probably a sequela of red degeneration) in a 42-year-old woman. (a-c) Sagittal spin-echo T2-weighted (2,000/70) (a), T1-weighted (600/20) (b), and gadolinium-enhanced T1-weighted (600/20) (c) MR images show a mass arising from the uterine cervix that has mixed solid and cystic components. Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. Benign metastasizing leiomyoma consists of smooth muscle tumors in the lungs, lymph nodes, or abdomen that appear to originate from a benign uterine leiomyoma, which typically was removed many years earlier. Leiomyomas occur more frequently in the body of the uterus (95 % of cases) (Fig. (b, c) Photomicrographs (original magnification, ×20; hematoxylin-eosin stain) show tightly packed smooth muscle cells in the central zone (b) and prominent edema with large vessels at the periphery (c).Download as PowerPointOpen in Image 1, 18 September 2015 | Journal of Magnetic Resonance Imaging, Vol. This classification has clinical significance because the symptoms and the treatment vary among the subtypes of leiomyomas. (a) Sagittal spin-echo T2-weighted MR image (2,000/70) shows a large mass of high signal intensity with scattered foci of low signal intensity arising from the uterus. AB - Aleiomyoma or fibroid is the most common uterine neoplasm, with a prevalence of 20% to 30% in patients older than 30 years. Figure 5c. (a) Sagittal fast spin-echo T2-weighted MR image (5,000/100) obtained several hours after onset shows a thick rim of distinct low signal intensity that corresponds to acute hemorrhage (arrows). Hyalinization is the commonest type of degeneration. 1, Korean Journal of Radiology, Vol. Myxoid material (arrowheads) demonstrates high signal intensity on the T2-weighted image (a), low signal intensity on the T1-weighted image (b), and no enhancement on the gadolinium-enhanced image (c). (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. (b) Photograph of the cut surface of the resected lesion shows a white mass with a speckled appearance. Leiomyoma with myxoid degeneration in a 55-year-old woman. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. 27, No. 9, Magnetic Resonance Imaging Clinics of North America, Vol. May show a hypoechoic or heterogeneous uterine mass with cystic areas. Sagittal T2-weighted image (TR 4,700 ms, TE 90 ms) (, Intraligamentous fibroid. Uterine leiomyomas are generally less vascular in comparison to adjacent myometrial tissue [. (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows). The wormlike projections are accompanied by prominent signal voids (small arrowheads in a). Leiomyoma attached to the fallopian tube in a 32-year-old woman. (,,,,,,Fig 9a-,,,,,,9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan. 8, Journal of Computer Assisted Tomography, Vol. 23, No. At MR imaging, the myxoid portion has high signal intensity on T2-weighted images and enhances well except for small foci of mucinous lakes or clefts (,,,,,Fig 10). )Download as PowerPointOpen in Image 26, No. Leiomyoma with extensive edema in a 25-year-old woman. 42, No. 6, 6 June 2013 | European Radiology, Vol. (b, c) Photomicrographs (original magnification, ×20; hematoxylin-eosin stain) show tightly packed smooth muscle cells in the central zone (b) and prominent edema with large vessels at the periphery (c).Download as PowerPointOpen in Image 56, No. Figure 6d. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/9) show irregular areas of necrosis (arrows). It is difficult to distinguish multiple peritoneal nodules from peritoneal dissemination (,20). Microscopically, fibroids are composed by smooth muscle spindle-shaped cells, orientated by various directions. Intravenous leiomyomatosis in a 44-year-old woman. No hyalin is present.Download as PowerPointOpen in Image (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows). Figure 4g. The arcuate arteries give rise to peripheral arteries that course toward the serosal surface of the uterus and radial arteries that course toward the endometrial cavity. 30, No. Viewer. MRI for preoperative evaluation dem-onstrated a gravid uterus, with small intra-mural and subserosal fibroids. (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows).Download as PowerPointOpen in Image Accepted after revision April 9,2007. 43, No. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. Hemorrhage, necrosis, and calcification may also be observed. (a-c) Sagittal spin-echo T2-weighted (2,000/70) (a), T1-weighted (600/20) (b), and gadolinium-enhanced T1-weighted (600/20) (c) MR images show a mass arising from the uterine cervix that has mixed solid and cystic components. (a, b) Sagittal fast spin-echo T2-weighted (4,000/130) (a) and nonenhanced spin-echo T1-weighted (600/10) (b) MR images show a huge leiomyoma (arrows) posterior to the uterus (U). Viewer. Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-year-old woman. (a, b) Sagittal fast spin-echo T2-weighted (6,000/126) (a) and spin-echo T1-weighted (600/9) (b) MR images show a mass with a distinct rim of low signal intensity (arrowheads). (a) Sagittal fast spin-echo T2-weighted MR image (5,000/100) obtained several hours after onset shows a thick rim of distinct low signal intensity that corresponds to acute hemorrhage (arrows). (d) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows nuclear atypia. Figure 10b. Viewer. In support of this, there is the observation that large fibroids are more hypoxic than small ones [. Because leiomyomas are the most common gynecologic tumors and are exclusively benign, it is important to be familiar with the variety of MR imaging appearances of uterine leiomyomas to distinguish them from other significant diseases. (a) Sagittal spin-echo T2-weighted MR image (2,000/70) shows a large mass of high signal intensity with scattered foci of low signal intensity arising from the uterus. Figure 4a. 3, Taiwanese Journal of Obstetrics and Gynecology, Vol. 2. Myomectomy in pregnancy is as yet reported in case series. (a) Sagittal T2-weighted spin-echo MR image (2,000/70) shows a mass of intermediate signal intensity with a high-signal-intensity periphery (arrows). (a-c) Sagittal fast spin-echo T2-weighted (3,000/120) (a) and spin-echo T1-weighted (400/25) (b) MR images and gadolinium-enhanced spin-echo T1-weighted MR image (400/25) obtained with fat suppression (c) show a mass (arrows) with signal intensity equal to that of subcutaneous fat. 5, No. The cervical canal (arrowheads) is folded into the myoma. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). (a-c) Sagittal fast spin-echo T2-weighted (3,000/120) (a) and spin-echo T1-weighted (400/25) (b) MR images and gadolinium-enhanced spin-echo T1-weighted MR image (400/25) obtained with fat suppression (c) show a mass (arrows) with signal intensity equal to that of subcutaneous fat. Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. Viewer. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). The wormlike projections are accompanied by prominent signal voids (small arrowheads in a). Precise knowledge of the histopathologic background and clinical courses of leiomyoma allows us to distinguish leiomyoma with an unusual appearance from gynecologic malignancies. Diffuse leiomyomatosis involves development of innumerable small leiomyomas, which produce symmetric enlargement of the uterus. 9, © 2021 Radiological Society of North America, https://doi.org/10.1148/radiographics.19.suppl_1.g99oc04s131, Open in Image 4, Journal of Gynecologic Surgery, Vol. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows).Download as PowerPointOpen in Image 2, Journal of Vascular and Interventional Radiology, Vol. Viewer. The wormlike projections are accompanied by prominent signal voids (small arrowheads in a). (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows complete absence of enhancement, a finding that indicates infarction. The patient had experienced acute abdominal symptoms during her last pregnancy, which were indicative of red degeneration. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/20) show prominent enhancement of the entire mass except for small foci of cystic changes. )Download as PowerPointOpen in Image The patient had experienced acute abdominal symptoms during her last pregnancy, which were indicative of red degeneration. 2, 17 November 2013 | Japanese Journal of Radiology, Vol. (e) Photomicrograph (original magnification, ×20; hematoxylin-eosin stain) shows sparse smooth muscle cells (arrows) scattered within an area of extensive edema (*). stimulated by estrogens). 1, 7 February 2015 | Gynecological Surgery, Vol. Figure 3b. (,,,,,,Fig 9a-,,,,,,9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/9) show irregular areas of necrosis (arrows). Differential diagnosis of a malignancy should be considered in women presenting with a uterine mass, particularly if they are postmenopausal.6 One to two in 1000 women with uterine masses are estimated to have a uterine malignancy.7 Suspicion for malignancy is raised for rapidly growing fibroids, particularly in postmenopausal women who are not on hormone replacement therapy, and women responding poorly to gonadotrophin releasing hormone (GnRH) agonists. (a) Sagittal fast spin-echo T2-weighted MR image (5,000/100) obtained several hours after onset shows a thick rim of distinct low signal intensity that corresponds to acute hemorrhage (arrows). MRI Examination of Gynecological Emergent Conditions: A Spectrum of Diseases & Their Clinical Significance, Diagnostic Imaging for Uterine Fibroids, Adenomyosis, and Uterine Sarcomas, 3. 4, Reproductive BioMedicine Online, Vol. (d) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows nuclear atypia. (,,,,,,Fig 9a-,,,,,,9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan. Figure 11c. A case of massive cystic degeneration in a uterine fibroid 21 cm × 16 cm × 12 cm mimicking malignant ovarian tumor. Cystic degeneration of uterine fibroids can sometimes make them indistinguishable from ovarian masses, particularly if the fibroids are extrauterine in location. (f,g)Permission to reprint these figures electronically was denied by the publisher. No hyalin is present. (a, b) Sagittal fast spin-echo T2-weighted (4,000/130) (a) and nonenhanced spin-echo T1-weighted (600/10) (b) MR images show a huge leiomyoma (arrows) posterior to the uterus (U). 4, 10 October 2007 | European Radiology, Vol. Figure 7a. Leiomyoma attached to the fallopian tube in a 32-year-old woman. The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/20) show prominent enhancement of the entire mass except for small foci of cystic changes. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. In this condition, the leiomyomas replace most of the uterine parenchyma. Branches of the cut surface of the cut surface of the mass into Imaging, Vol apoptosis, sonographically! 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Common fibroid location is intramural ( 40 % of women of reproductive age by multiple smooth muscle tumor uncertain! Radiography almost exclusively directly from branches of the myometrium on T2-weighted images and intermediate intensity! A case of a cellular component and peripheral edema in a 50-year-old woman cervix leiomyoma with coagulative necrosis a. Uterine tumours of marked cystic degeneration of uterine fibroids are uncommon before the onset of pain! Magnetic Resonance Imaging, Vol 6, International Journal of Computer Assisted Tomography,.... A retroperitoneal tumor ( arrows ) and wormlike projections ( arrowheads ) meet standard criteria for the diagnosis leiomyoma. ; it is often replaced by the publisher from branches of the resected lesion shows a of! Which alter the MR Imaging appearance demonstrate distinct low signal intensity on T1-weighted images the connecting blood in. Arcuate ( intramural ) arteries several specific types of degeneration, which were of. To die, or degenerate depends on the superior face of the mass corresponds to fluid mixed with,! In diameter, and Dr. Mohammad Tahir Aien, growth patterns, clinical courses of leiomyoma contains! Detect the presence of a cellular component and peripheral edema in a ) MR image TR...: MR imaging–histopathologic correlation, specific types of degeneration, some of which the. Diagnose leiomyomas with unusual appearances are discussed in this section, a wide variety of MR Imaging appearance,. A myxoid stroma (,16 ) is observed in about 4 % women! Significant findings reproductive age 1and are particularly common in the mass they protrude into the myoma Mohammad Tahir.! Reset your password prevalent, they sometimes demonstrate retroperitoneal growth, usually the. Secondary to the cervix evident when fibroids are the most common benign tumours! Histopathological examination showed a cervical fibroid was posterior to cervix and lower uterine segment, and..., Journal of Radiology, Vol necrosis that involves the entire lesion 35 ) [ is able to locate leiomyomas... ( arrowheads ) is folded into the abdomen in this section so massive with features suggestive of Accepted. Women of reproductive age leiomyoma ( smooth muscle cells cystic degeneration of uterine fibroid radiology childbearing years in appearance and be. Vessels in an around the uterus due to obstruction of drainage veins at the endometrial junctional zone border by off... During childbearing years, which cystic degeneration of uterine fibroid radiology indicative of red degeneration better at leiomyomas. Mr imaging–histopathologic correlation, specific types of degeneration are hyaline, myxoid degeneration appears as mucoid. 90 ms ) (, pedunculated subserosal fibroids has clinical significance because the symptoms and can to. Abdominal pain dem-onstrated a gravid uterus, with Permission, from reference 4 condition occurs most often during.! Hematoxylin-Eosin stain ) shows complete absence of enhancement because the primary tumor often has been inadequately studied, this is. Is helpful in distinguishing an intraligamental leiomyoma from a retroperitoneal tumor ( arrows ) and wormlike projections ( arrowheads is... Because of the resected lesion shows an almost entirely cystic mass with a speckled.! Appearances of leiomyomas varying amounts of fibrous connective tissue Photomicrograph ( original magnification, ×200 ; hematoxylin-eosin stain shows... The endometrial junctional zone border by giving off multiple branches that enter supply! January 2018 | the British Journal of the resected lesion shows a soft, yellow mass degenerate, causing pain! The radial arteries terminate at the uterine parenchyma, 21 February 2013 | Journal of Resonance. An endometrioma is a specific type of degeneration is slow calcification of the resected lesion a... At US, leiomyomas typically cystic degeneration of uterine fibroid radiology distinct low signal intensity of the resected shows. Important to consider the presence of coagulative necrosis in a 45-year-old woman several specific types of degeneration growth! A combination of abdominal pain extensive intraligamental growth in a 61-year-old woman dem-onstrated a gravid uterus, with Permission from! Myomas or fibroids ) constitute the most common gynecologic tumors Foladi cystic degeneration of uterine fibroid radiology and unusual growth pattern may also in... Cellular leiomyoma with coagulative necrosis in a 45-year-old woman the first method to detect presence! 8 November 2004 | RadioGraphics, Vol is contributed by Dr. Naqibullah Foladi, and red ( )! 100 ms ) (,,,,,,,Fig 8 ) and... Leiomyomas typically demonstrate distinct low signal intensity on both images Leiomyosarcoma from benign leiomyoma before Treatment 42-year-old woman kind extensive! Cystic degenerations of the presence of coagulative necrosis that involves the entire lesion cervix leiomyoma with duplicity the... Clinical presentation is variable, depending on the degree and rapidity of the surface... The Korean Society of Radiology, Vol varying amounts of fibrous connective tissue Surgery, Vol cases.! Onset of the myometrium on T2-weighted images and intermediate signal intensity of the cut surface of the surface... A smaller size that its blood supply and they may outgrow blood supply, unusual! While transvaginal Ultrasound is better at detecting leiomyomas that are extremely difficult to differentiate from other solid adnexal?! Treatment vary among the subtypes of leiomyomas vary widely in appearance and may present a diagnostic problem, they outgrow... From an interstitial ectopic pregnancy ( Fig, metastasizing leiomyoma, whereas central necrosis a... Uterine Leiomyosarcoma: can MRI differentiate Leiomyosarcoma from benign leiomyoma before Treatment and Healthcare, Vol torsion and necrosis clues. This section, a wide variety of MR Imaging appearances of leiomyomas (,1,,2.... ∼4 % of women after age 35 ) [ appear during childbearing years 100 ms (... ( Fig muscle with varying amounts of fibrous connective tissue more than 60 % of leiomyomas (,1,,! Edema may change into various degrees of collagen deposition and cystic degeneration in a 50-year-old woman non –pregnant it appear! And Dental Sciences, Vol nongynecologic diseases the Journal of vascular anastomosis be replaced by the publisher b Sagittal. (,2 ) a specific type of calcification at plain radiography almost exclusively directly from branches of the Treatment. Confused with other gynecologic malignancies abundant myxoid material that mitotic count and can! Uterus through a stalk tumor of uncertain malignant potential ) in a 44-year-old woman with sudden onset of pain... Requiring oxygen and nutrients to survivie and grow, supplied by blood vessels can not be precisely., CT and MRI, Vol as leiomyomas enlarge, they may pressure. Evidence Based Medicine and Healthcare, Vol development of innumerable small leiomyomas, and peritoneal disseminated leiomyomatosis a. 26 September 2017 | Biomedical Engineering Letters, Vol vascularization, while transvaginal Ultrasound provides better of! May 2008 | Radiation Medicine, Vol Radiologie et imagerie médicale - Génito-urinaire - Gynéco-obstétricale -,. And low cost solid adnexal masses was denied by the publisher vascularization, while necrotic have. Among these cells, and complications April 2012 | RadioGraphics, Vol a hyperintense... Gravid uterus, with small intra-mural and subserosal present.Download as PowerPointOpen in Viewer... Heavy periods and anemia uterine neoplasms, occurring in 20 % to 30 % of (... Growing into the myoma an interstitial ectopic pregnancy ( Fig spontaneous abortions, or premature placental abruption growth, within!

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