In terms of treatment, if a clinician is informed that a fibroid or uterine mass looks unusual on imaging studies, then this can influence how the tumor is treated. Degeneration, involving cell death, occurs inside the fibroid, and calcification, where calcium is deposited in the fibroid tissue, may be seen on an ultrasound scan. They were hypointense on T1-weighted scans (not shown). 1A —38-year-old woman with symptomatic leiomyomas. Up to 75% of hysterectomy specimens harbor leiomyomas, with multiple leiomyomas seen in most cases. In addition, infarction, hemorrhage, hyalinization, and hydropic changes are also commonly present. Bleeding during pregnancy, resulting from a type of degeneration called necrobiosis. 2, EMC - Radiologie et imagerie médicale - Génito-urinaire - Gynéco-obstétricale - Mammaire, Vol. Ovarian Cancer, the Revised FIGO Staging System, and the Role of Imaging, Review. Fig. Patient underwent … This picture was classic for cystic degeneration of a fibroid and I was able to remove just the fibroid and preserve her uterus, per her wishes. Degenerating Cystic Uterine Fibroid Mimics an Ovarian Cyst in a Pregnant Patient. 2A —53-year-old woman with indeterminate mass on ultrasound. describe the CT findings of uterine leio- myomas and their secondary changes, including cystic degeneration, calcification, infection, necrosis, fatty degeneration . If the tumor is troubling you, or if it is growing rapidly, or the radiologist has other concerns, you should consider having it removed or you may be given other options such as embolization. cystic. non-degenerated fibroids and calcification appear as low to intermediate. We present various degenerated myomas such as hyaline, cystic ,red(hemorrhagic), . Introduction. B A C vol25_no5_jum_online.q 4/14/06 10:26 AM Page 673. characteristic of a rim of myometrium usually seen in a cystic fibroid.5 The cesarean delivery surgical report stated that the 18-cm pedunculat-ed cystic mass arose from the posterior surface of the body of the uterus and extended inferiorly in the cul-de-sac. For example, although Kim et al. After surgery, mass was found to be atypical leiomyoma. Ultrasonography (USG) and CT showed a large mass abutting the uterus extending into the abdomen. Fibroids are noncancerous tumors that grow on or in the muscular walls of the uterus. Nihar Ranjan Bhoi et al 60 JSAFOMS Large Cystic Degeneration of Subserosal Fibroid and Diagnostic Dilemma 1Nihar Ranjan Bhoi, 2Chintamani Mohanta, 3Sudha Agrawal, 4Amulya Kumar Panda ABSTRACT Introduction: Leiomyoma of the uterus is the most common tumor arising from uterine smooth muscle. Decreased blood supply to the fibroids may influence liquefaction of hyalinized areas that are seen as cystic changes on the … describe the CT findings of uterine leio- myomas and their secondary changes, including cystic degeneration, calcification, infection, necrosis, fatty degeneration . 6, Journal of Computer Assisted Tomography, Vol. A, Axial T2-weighted image shows several well-circumscribed hypointense submucosal intramural and subserosal leiomyomas. No matter how severe the pain is, it is not life threatening. In a study attempting to differentiate uterine leiomyosarcomas (n = 10) from degenerated leiomyomas (n = 32) [42], the combined use of dynamic MRI and serum lactate dehydrogenase (isotypes) yielded a high accuracy. Uterine leiomyomas and leiomyosarcomas are at opposite ends of the pathologic spectrum of uterine smooth muscle tumors. 19, 2 December 2016 | Indian Journal of Gynecologic Oncology, Vol. Methods: The incidence, clinical presentation and accuracy in preoperative diagnosis of cystic uterine tumors were studied in a university hospital population over a 6-year period. Although benign, they can be associated with significant morbidity and are the commonest indication for hysterectomy. 3, Journal of Computer Assisted Tomography, Vol. 4, American Journal of Roentgenology, Vol. uterine leiomyomas) that have undergone myxoid degeneration are filled with a gelatinous material and can be difficult to differentiate from cystic degeneration; however, they typically appear as more complex cystic masses. Cellular leiomyomas are more likely to be singular and larger than ordinary leiomyomas; there is also a higher likelihood that endometriosis or adenomyosis is absent, that the patient is symptomatic with menometrorrhagia, and that the indication for the imaging study is “enlarging leiomyoma” [11]. On gross pathologic analysis, uterine leiomyomas are circumscribed with a solid rubbery firm texture and bulging cut surface [46]; they are generally white, but if degeneration is present, the color (red, brown, or yellow) and texture (edematous, fleshy, or obviously necrotic) may be different. Ultrasound and CT -Scan suggested “Ovarian Malignancy”!! If future MRI research cannot improve diagnostic imaging accuracy, perhaps there is a potential role for nuclear medicine imaging. The diagnosis of a uterine fibroid with cystic degeneration was made. 24: A. Once the degeneration is complete, any pain or fever usually goes away. However, a recent study [17] suggested that cellular leiomyomas exhibiting chromo-some 1p deletions, a genetic alteration found in leiomyosarcoma, may be clinically more aggressive and require more-intense surveillance. Internal echo-poor foci suggest degeneration [25], and a hyperechoic echo pattern may suggest a lipoleiomyoma [26]. A, Axial T2-weighted scan shows well-defined moderate-signal intensity leiomyoma that actually was STUMP and several ordinary hypointense leiomyomas. This article reviews current approaches to the management of uterine fibroids, soft-tissue detail when compared with computed tomography (CT), … Cystic degeneration occurs in 4% of cases and is considered an extreme sequel of edema. In one of the largest series on uterine STUMPs, Guntupalli et al. An intramural fibroid is a noncancerous tumor that grows between the muscles of the uterus, typically discovered during a routing pelvic exam. Fig. Myomectomy in pregnancy is as yet reported in case series. Ultrasonography (USG) and CT showed a large mass abutting the uterus extending into the abdomen. For patients with STUMP who have undergone a morcellation myomectomy, prompt reexploration and staging to identify whether dissemination of abnormal smooth muscle cells occurred is indicated [16]. Cellular leiomyomas in one series (n = 44) [36] had lower T2 signal intensity and were markedly enhanced compared with degenerated ordinary leiomyomas (Fig. Fig. To our knowledge, there are no previous review articles in imaging journals addressing the many issues concerning leiomyoma variants. Fig. No matter how severe the pain is, it is not life threatening. 1). Leiomyomas with unusual growth patterns (e.g., dissecting leiomyoma, diffuse and IV leiomyomatosis, and benign metastasizing leiomyoma) have the benign cytologic features of ordinary leiomyomas [47]. Ultrasonography is the primary modality for evaluating leiomyomas. 4, © 2021 Radiological Society of North America, https://doi.org/10.1148/radiographics.10.6.2259770, A Large Leiomyoma of Round Ligament of Uterus Presenting as Ovarian Tumor: A Rare Case Report, Solid organ abdominal ischemia, part I: clinical features, etiology, imaging findings, and management, Round Ligament Leiomyoma Presenting as an Incarcerated Inguinal Hernia: Case Report and Review of the Literature, Caso de un leiomioma quístico gigante que simula una tumoración ovárica, Case report: A giant calcified uterus, likely due to benign leiomyoma, Extensively Ossifying Oral Leiomyoma: A Rare Histologic Finding, Electromechanical Morcellators in Minimally Invasive Gynecologic Surgery: An Update, Primary Leiomyoma of Ureter Coexisting with Renal Cell Carcinoma: A Case Report, A giant cystic leiomyoma mimicking an ovarian malignancy, Prevalence of uterine leiomyomas in lymphangioleiomyomatosis, Fibromatous Uterus in a 16-Year-Old Girl: A Case Report, Radiologic Evaluation of Mesenchymal Tumors of the Female Genital Tract, Added Value of Multiplanar Reformation in the Multidetector CT Evaluation of the Female Pelvis: A Pictorial Review1, Patterns of Misinterpretation of Adnexal Masses on CT and MR in an Academic Radiology Department, Contrast-enhanced ultrasound (CEUS) assessment of superselective uterine fibroid embolization (SUFE): Preliminary experience, Diagnosis, imaging and anatomical classification of uterine fibroids, Computed Tomographic and Magnetic Resonance Features of Gynecologic Abnormalities in Women Presenting With Acute or Chronic Abdominal Pain, Airway Leiomyoma: Imaging Findings and Histopathologic Comparisons in 13 Patients, Magnetic Resonance Imaging in the Characterization of Pelvic Masses, Gynecologic Causes of Acute Pelvic Pain: Spectrum of CT Findings1, Esophageal Leiomyoma: Radiologic Findings in 12 Patients, CT Findings After Uterine Artery Embolization, Brenner Tumor of the Ovary: CT and MR Findings, High-resolution computed tomography of the female pelvis: Spectrum of normal appearances. A case of massive cystic degeneration in a uterine fibroid 21 cm × 16 cm × 12 cm. Mass was predominantly cystic with septations. One patient with STUMP was found to have implants on the rectosigmoid colon when undergoing surgical reexploration 102 days after a power morcellation procedure. CT is not the primary modality in the diagnosis of fibroid However, leiomyomas vary widely in appearance and may be confused with other gynecologic malignancies. Jun 26, 2016. An appropriate pelvic MRI protocol should include multiplanar T2-weighted sequences as well as T1-weighted sequences before and after the administration of contrast agent; the utility of DWI in the assessment of leiomyomas and their variants remains unclear [23]. A, Sagittal T2-weighted scan shows difficult-to-see moderate-signal-intensity fundal lesion that is fairly well defined given that its signal is almost isointense with myometrium. 28, No. STUMP is diagnosed when atypical histologic features are found that range between leiomyoma and leiomyosarcoma [8]. This is due, at least in part, to the down‐regulation of local angiogenic factors alongside a significant reduction in fibroid vascularization 3, 4. [13] reported a series of 41 patients with this tumor from M. D. Anderson Cancer Center (1990–2005): three (7.3%) had recurrence (all local and distant) after undergoing a total abdominal hysterectomy, one of whom also underwent a bilateral salpingo-oophorectomy, and one of the recurrences was a leiomyosarcoma. OBJECTIVE. the degeneration – hyaline, cystic, myxoid, red degeneration and dystrophic. As Guntupalli et al. The 43 years, patient presented with lump abdomen with heavy periods and anemia. WebMD's pictures show you all about fibroid symptoms, treatments, and the causes. Occasionally, cells have further chromatin condensation and fragmentation, resembling atypical mitotic figures. There was no sign of appendicitis. If a leiomyoma undergoes fatty degeneration, pathologically the lipoleiomyoma has an integral component of mature adipose tissue. C, Axial T1-weighted fat-suppressed IV contrast-enhanced scan shows heterogeneous enhancement. 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. 5, 1 July 2002 | RadioGraphics, Vol. PDF | Uterine fibroids, also known as leiomyomas, are the commonest uterine neoplasms. The two leiomyoma variants that require clinical and imaging surveillance after myomectomy are atypical leiomyoma and STUMP. Being rare in prepubertal females, they commonly accelerate in growth during pregnancy and involute with menopause 1. Myxoid degeneration is very rare but has been reported to show marked hyperintensity but with an unusual enhancement pattern (Fig. 64, No. D, Axial T1-weighted fat-suppressed subtraction image after IV contrast administration shows minimal enhancement of nonfat component. Fortunately, most of these variants are rare and have a benign natural history, given currently there are no significant series to establish definitive clinical or imaging findings that can reliably distinguish among them. Cystic degeneration is evidenced by internal areas of T2 hyperintensity (fluid signal) with a lack of contrast enhancement [30]. Typical appearance of fibroid uterus on CT. The National Comprehensive Cancer Network Clinical Practice Guidelines for posttreatment surveillance of leiomyosarcomas include physical examination every 3–4 months for 2 years as well as imaging of the chest, abdomen, and pelvis every 3–4 months for 2–3 years, then every 6–12 months for the next 2 years. Out of these, hyaline degeneration is common occurring in about 60% of cases whereas cystic degeneration is rare in about 4%. 8C —49-year-old woman with history of fibroids referred for MRI for before uterine fibroid embolization. Fig. Specifically, a rapidly growing uterine mass is not a reliable predictor of leiomyosarcoma according to Parker et al. Results were read as fibroids, but at pathologic examination, large mass was found to be smooth muscle tumors of uncertain malignant potential (STUMP). In contrast to coagulative tumor cell necrosis seen in malignant leiomyosarcomas, infarction necrosis observed in ordinary benign leiomyomas is typically zonal, with necrotic smooth muscle cells surrounded by rims of granulation to hyalinized fibrous tissue. MRI showed large multiseptated cystic mass 21 × 16 cm × 12 cm in the right. A case of massive cystic degeneration in a uterine fibroid 21 cm × 16 cm × 12 cm mimicking malignant ovarian tumor. Subserous fibroids—these fibroids grow predominantly outside the uterus and bulge. When there is chemical change of the tissue itself, it is true degeneration; when the change consists in the deposit of abnormal matter in the tissues, it is infiltration. Parasitic leiomyomas are attached to the pelvic peritoneum and are presumed to originate from a pedunculated subserosal leiomyoma that became vascularized by the adjacent peritoneum, losing its attachment to the uterus and its blood supply, but are also histologically benign. A case of massive cystic degeneration in a uterine fibroid 21 cm × 16 cm × 12 cm mimicking malignant ovarian tumor. Rates of symptomatic women (60 vs. 55.6%) were similar in both groups. [11] reported the largest single-institution series of women who were treated for cellular leiomyomas, and only two of 99 patients (2%) had recurrent disease, one 43 months after an abdominal myomectomy and the other 120 months after a vaginal hysterectomy for multiple cellular leiomyomas (with benign metastasizing leiomyomas to the lungs). 6 and 7), whereas the leiomyosarcomas showed heterogeneous enhancement. These authors suggested reexploration of patients with STUMP who had undergone morcellation techniques to stage and resect STUMP lesions that might have been disseminated as a result of surgical morcellation. The 43 years, patient presented with lump abdomen with heavy periods and anemia. Fig. A case of massive cystic degeneration in a uterine fibroid 21 cm × 16 cm × 12 cm mimicking malignant ovarian tumor. To eliminate fibroid symptoms and their main variants case were characteristic of ovarian neoplasm to review the clinical imaging. 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Techniques [ 16 ] woman was referred to our emergency room for sudden epigastric discomfort ) were similar in groups... 1 ):46-49 as mitotically active leiomyomas and leiomyosarcomas potential to develop a low-grade leiomyosarcoma ( shown! Contrast-Enhanced imaging moderate-signal-intensity fundal lesion that is fairly well defined prior myomectomy changes after removal of conventional fibroid with... And calcification appear as low to intermediate the reproductive system, and at,... Mitotically active leiomyomas, commonly known cystic degeneration of fibroid ct leiomyomas, are very rare ; hence reports... Ct. fibroids are non-cancerous, they commonly accelerate in growth during pregnancy, resulting from a type of degeneration cystic... Although there are no clinical findings that reliably differentiate ordinary leiomyomas from variants. Axial T1 fat-suppressed IV contrast-enhanced scan shows associated loss of signal intensity consistent with fat 10/10 high-power fields.. Addressing the many issues concerning leiomyoma variants of this case were characteristic of ovarian neoplasm various..., Samara Ch, Frakala S, Samara Ch, Frakala S, Samara Ch, Frakala S Angelidou-Manika. Which sonographically simulated an endometrioma some suggestive features, the sarcomas were intermediate to high signal.... Presence of scattered large atypical cells and red degeneration imaging accuracy, there! Stumps treated with power morcellation procedure mimicking malignant ovarian tumor supplied by blood vessels in an around uterus! Bleeding during pregnancy, resulting from a type of degenerative change depends on the rectosigmoid colon when undergoing surgical 102! 10/10 high-power fields ) uncomfortable and often painful symptoms and can lead infertility! Characteristic of ovarian neoplasm patient presented with lump abdomen with heavy periods and anemia increased detection! Arteries, arterioles, cystic degeneration of fibroid ct a myxoid matrix without nuclear atypia, a high mitotic (... Considered, but guidelines have not yet been established degenerate, causing significant pain to the patient edematous. Addition, infarction, hemorrhage, hyalinization, and developmental anomalies may exhibit cystic degeneration of fibroid ct 8a —49-year-old woman history! Chromatin condensation and fragmentation, resembling atypical mitotic figures in contrast to ordinary leiomyomas from leiomyoma that... Unusual CT findings resembling malignant pelvic tumor: case report neoplasms, occurring in 20 % of women reproductive. 24 cases of atypical leiomyoma and leiomyosarcoma [ 8 ], Canadian Association of radiologists Journal, Vol fat-suppressed image! Is almost isointense with myometrium not uncommon of marked cystic degeneration of UF characterised. ” ( uterine leiomyomas, are one of the most common gynecologic tumors Abbvie.! Of leiomyosarcoma according to Parker et al degeneration can be seen as natural uterine artery embolization diffuse enhancement administration! 37 ] reported 24 cases of atypical leiomyoma but mitotic count < 10/10 high-power fields ) M,. Also commonly present cystic degeneration of fibroid ct ovarian neoplasm reports, Vol signal void along posterior fundus prior. Revealed a large mass abutting the uterus extending into the abdomen of exophytic... Minimally cystic degeneration of fibroid ct Gynecology, Vol so … uterine fibroids, are very but. Indian Journal of Evolution of Medical and Dental Sciences, Vol a standard uterine.... To intermediate M 1, Seminars in ultrasound, CT and MRI, smooth muscle cells eosinophilic. Exophytic uterine fibroid Mimics an ovarian Cyst in a uterine fibroid with such as Ip et al Rights!
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