They occur in ~25% of women of reproductive age 1and are particularly common in the African population. (a) Sagittal fast spin-echo T2-weighted MR image (6,000/126) shows a mass of relatively low signal intensity. 22, No. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. (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). (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. Other types include: myxomatous, calcification, mucoid, cystic, red and fatty degeneration . Uterine leiomyomas are well-defined masses in the myometrium, with a homogeneous low signal intensity on T2-weighted images (TR 4,000 ms, TE 100 ms) (, Multiple uterine leiomyomatosis. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. Leiomyoma with myxoid degeneration in a 55-year-old woman. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. Figure 1a. The first two types may have MR imaging findings characteristic enough to allow diagnosis and are discussed in this section. Figure 5b. Often fibroids >5–8 cm in diameter degenerate. (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows).Download as PowerPointOpen in Image Edema is not a phenomenon of degeneration but is a common histopathologic finding, present in about 50% of leiomyomas (,1). Uterine leiomyomas are generally less vascular in comparison to adjacent myometrial tissue [. T1 1, Nuclear Medicine Communications, Vol. (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). 3, Journal of Medical Ultrasound, Vol. Intravenous leiomyomatosis in a 44-year-old woman. It is important to consider peripheral lymphedema in the diagnosis of leiomyoma, whereas central necrosis is a common finding in ovarian tumors. Figure 8c. (c) Photograph of the resected specimen shows the subserosal tumor (arrows) and wormlike projections (arrowheads).Download as PowerPointOpen in Image (c) Gadolinium-enhanced spin-echo T1-weighted MR image (600/9) shows complete absence of enhancement. When fibroids bec… 38, No. 48, No. Unusual appearances are discussed from three points of view: MR imaging–histopathologic correlation, specific types of unusual leiomyomas, and unusual growth patterns. (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. 2, 8 November 2004 | Abdominal Imaging, 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.Download as PowerPointOpen in Image However, pelvic MR imaging provides better soft-tissue contrast resolution, lack of operator dependence, and decreased variability in interpretation of images when compared with transvaginal US. 5, Journal de Gynécologie Obstétrique et Biologie de la Reproduction, Vol. Leiomyoma with extensive intraligamental growth in a 55-year-old woman. (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. Fibroids with this type of degeneration may show cystic areas with … 56, No. Relatively rare, myxoid leiomyomas contain abundant myxoid material between smooth muscle cells. Leiomyoma consisting of a cellular component and peripheral edema in a 45-year-old woman. (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). Precise knowledge of the histopathologic backgrounds of degeneration and the clinical course helps us accurately diagnose leiomyomas with unusual appearances. 25, No. 43, No. 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). Leiomyoma with myxoid degeneration in a 55-year-old woman. (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). 5, 5 December 2016 | European Radiology, 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. (Reprinted, with permission, from reference 4. Among these cells, there is varying amount of fibrous connective tissue. (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. 2, European Journal of Radiology, Vol. 46, No. 3, Seminars in Ultrasound, CT and MRI, Vol. Figure 3d. 40, No. (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 4d. Subserosal leiomyoma with extensive cystic degeneration in a 61-year-old woman. )Download as PowerPointOpen in Image (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. (e) Photomicrograph (original magnification, ×20; hematoxylin-eosin stain) shows sparse smooth muscle cells (arrows) scattered within an area of extensive edema (*). 33, No. (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. 2, 6 November 2007 | Australasian Radiology, Vol. Huge cervical leiomyoma in a 32-year-old woman. (,,,,,,Fig 9a-,,,,,,9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan. (d) Photograph of the cut surface of the resected lesion shows a cystic mass filled with gelatinous material (arrowheads). (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). 31, No. 1/2, 14 June 2005 | European Radiology, Vol. Leiomyomas typically demonstrate distinct low signal intensity relative to that of the myometrium on T2-weighted images and intermediate signal intensity on T1-weighted images. Unusual-appearing uterine masses may best be treated surgically with myomectomy or hysterectomy rather than medically or with interventional radiology (i.e., uterine fibroid embolization). (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). (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. 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. (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). While fibroids are non-cancerous, they cause uncomfortable and often painful symptoms and can lead to infertility. The wormlike projections are accompanied by prominent signal voids (small arrowheads in a). Typical appearances of uterine leiomyoma at magnetic resonance (MR) imaging are well established, and diagnosis is usually easy. 202, No. 24, No. (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. Viewer. Leiomyoma with ring calcification (probably a sequela of red degeneration) in a 42-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). (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. The cervical canal (arrowheads) is folded into the myoma. They are typically multiple and are classified as submucosal, intramural and subserosal. Leiomyoma attached to the fallopian tube in a 32-year-old woman. Figure 4f. 2, Journal of Vascular and Interventional Radiology, Vol. 2, 1 July 2002 | RadioGraphics, Vol. 29, No. Fibroids are noncancerous tumors that grow on or in the muscular walls of the uterus. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. (b) Photograph of the cut surface of the resected lesion shows a white mass with a speckled appearance. 20, No. (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). 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). 7, 17 January 2017 | Biomedical Engineering Letters, Vol. Leiomyomas usually grow into the peritoneal cavity. (e) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. The entire lesion shows no enhancement, which indicates complete interruption of blood flow. Leiomyoma consisting of a cellular component and peripheral edema in a 45-year-old woman. 3, Japanese Journal of Radiological Technology, Vol. Figure 10b. Can a T2 hyperintense rim sign differentiate uterine leiomyomas from other solid adnexal masses? (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. However, they sometimes demonstrate retroperitoneal growth, usually within the broad ligament. Leiomyoma with extensive edema in a 25-year-old woman. Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). 23, No. (c) Photomicrograph (original magnification, ×100; hematoxylin-eosin stain) shows hyaline degeneration throughout the lesion (*). Figure 10d. Viewer, Figure 9c. Tissue characterization of uterine fibroids with an intravoxel incoherent motion model: The need for T Viewer, Figure 9a. Viewer. (c) Photograph of the cut surface of the resected lesion shows an almost entirely cystic mass with scanty solid tissue. Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). 15, No. Leiomyomas occur more frequently in the body of the uterus (95 % of cases) (Fig. Features of multiple uterine fibroids. 1, 18 September 2015 | Journal of Magnetic Resonance Imaging, Vol. Viewer. (d) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows nuclear atypia. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/9) show irregular areas of necrosis (arrows). The cervical canal (arrowheads) is folded into the myoma. Because the primary tumor often has been inadequately studied, this condition is still controversial. Leiomyoma consisting of a cellular component and peripheral edema in a 45-year-old woman. Figure 5c. Fibroids are uncommon before the onset of puberty and regress after menopause. 23, No. 27, No. 68, 28 July 2015 | SpringerPlus, Vol. Figure 14c. (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. The patient had experienced acute abdominal symptoms during her last pregnancy, which were indicative of red degeneration. Smooth muscle cells are so widely separated by abundant myxoid material that mitotic count and cellularity cannot be assessed precisely. (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). Figure 12. 5.12 Sagittal T2-weighted image (TR 3,400 ms, TE 80 ms) shows a bulky uterus with two heterogeneous low-signal-intensity fibroids that press on the bladder ( arrowheads ) and push the rectum ( arrow ) Cystic Fibroids Degeneration Cystic degeneration is not so common type of fibroids degeneration; it affects only 4% of all fibroids … There are various processes of fibroid degeneration. Figure 3c. 81, No. 7, 19 October 2012 | European Radiology, Vol. Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-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. Figure 4a. 25, No. 33, No. Patient with abnormal uterine bleeding. 4, 1 January 2006 | Journal of Magnetic Resonance Imaging, Vol. Submucosal and intramural fibroids may also cause infertility, spontaneous abortions, or premature placental abruption. )Download as PowerPointOpen in Image (f,g)Permission to reprint these figures electronically was denied by the publisher. 10, Journal of Gynecologic Surgery, Vol. (e) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. 26, No. The uterus may appear bulky or enlarged, with an abnormality in the normal contour. The signal intensity of the mass corresponds to fluid mixed with thin, interlacing tissue of intermediate signal intensity on both images. (Reprinted, with permission, from reference 4. (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). Thus, MRI is the most accurate imaging technique for detection and measuring fibroids (number, volume, and location of each fibroid; its signal intensity characteristics; and its enhancement characteristics), measuring uterine volume, and excluding whatever concomitant pathology that may increase the symptoms or may be the real cause of the symptomatology (Figs. The calcification is usually dense and amorphous. 28, No. The common types of degeneration are hyaline (>60% of cases), cystic (∼4%), myxoid, and red. 6, 1 September 2003 | Journal of Ultrasound in Medicine, Vol. Leiomyoma with myxoid degeneration in a 55-year-old woman. 6, Gynecologic Oncology Case Reports, Vol. At MR imaging, the fatty tissue demonstrates signal intensity similar to that of subcutaneous fat with all pulse sequences (,,,,,,Fig 9) (,15). Figure 14b. The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). Schematic shows the uterus demonstrating the different locations of fibroids (image from the web), Sagittal T2-weighted (TR 3,250 ms, TE 80 ms) (. Figure 7a. ), Figure 9d. (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. Fibroids are responsive to hormones (e.g. Viewer. (c) Gadolinium-enhanced spin-echo T1-weighted MR image (600/9) shows complete absence of enhancement. 192, No. Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. Viewer. Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). (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 39, No. Findings at MR imaging reflect the pathogenesis of this condition well and contribute to an accurate diagnosis (,9). Lipoleiomyoma in a 76-year-old woman. (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. 205, No. (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). 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). (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. The uterine artery is the first or the second branch of the anterior division of the internal iliac artery (also called the hypogastric artery) in 51 % of cases, and it has several branches: the cervicovaginal artery and the arcuate arteries. 9, Journal of Women's Imaging, Vol. Figure 14a. Specific types of unusual leiomyomas include lipoleiomyoma and myxoid leiomyoma, which may have MR imaging features characteristic enough to allow differentiation from other gynecologic and nongynecologic diseases. Viewer, Figure 9b. (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. (f,g)Permission to reprint these figures electronically was denied by the publisher. 9, 8 April 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. Ultrasonography (USG) and CT showed a large mass abutting the uterus extending into the abdomen. Huge cervical leiomyoma in a 32-year-old woman. In 80–90 % of cases, the ovarian artery originates directly anteromedially from the abdominal aorta a few centimeters below the renal arteries; rarely, they can originate from the renal, lumbar, adrenal, or iliac arteries [. Leiomyoma with extensive edema in a 25-year-old woman. (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). Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. See print version. Such degeneration is a kind of extensive coagulative necrosis that involves the entire lesion. 33, No. (c) Photograph of the cut surface of the resected lesion shows an almost entirely cystic mass with scanty solid tissue. 27, No. Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-year-old woman. (b) Photograph of the cut surface of the resected lesion shows a white mass with a speckled appearance. (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. 971, Seminars in Ultrasound, CT and MRI, Vol. 40, No. Huge cervical leiomyoma in a 32-year-old woman. 81, No. Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. Imaging. Uterine fibroid degeneration occurs when a fibroid outgrows its limited blood supply. (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). Leiomyomas are the most common uterine neoplasm and are composed of smooth muscle with varying amounts of fibrous connective tissue. (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. Longer, tortuous branches are described as “spiral arterioles.” Arterial blood from the spiral arterioles can pass directly into veins through arteriovenous anastomoses at multiple levels. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. (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). 27, No. 2, 27 August 2015 | Radiology, 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. Smooth muscle cells are so widely separated by abundant myxoid material that mitotic count and cellularity cannot be assessed precisely. (,,,,,,Fig 9a-,,,,,,9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan. 5, No. (Reprinted, with permission, from reference 4. It is estimated that 20-50% become symptomatic, with symptoms including abnormal uterine bleeding, pelvic pain, bowel or urinary obstruction, or pregnancy related complications [ 1 ]. 2 (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. (a) Sagittal fast spin-echo T2-weighted MR image (6,000/126) shows a mass of relatively low signal intensity. 74, No. 2, 7 October 2008 | European Radiology, Vol. In the literature, there have been reports of cystic uterine fibroids mim-icking endometrial hyperplasia,4 a postoperative 12, Radiologic Clinics of North America, Vol. (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). Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-year-old woman. 1, 7 February 2015 | Gynecological Surgery, Vol. 7, No. (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. Figure 10c. Leiomyoma consisting of a cellular component and peripheral edema in a 45-year-old woman. (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). 1, 25 January 2013 | Journal of Magnetic Resonance Imaging, Vol. Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-year-old woman. See print version.Download as PowerPointOpen in Image 42, No. degeneration is an ischemic change that is most commonly observed during pregnancy. (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). Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. originating from the anterior uterine wall with multiple adhesions, cystic fluid measured about 8.2litres. (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). Hemorrhage, necrosis, and calcification (∼4% of cases) may also be observed. 24, No. Figure 7d. 9, No. (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. Larger fibroids may be evaluated best using a combination of abdominal and transvaginal ultrasound techniques. 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). Figure 10a. Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. 32, No. (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. All of these lesions are considered to represent fatty metamorphosis of leiomyoma (,1,,5,,6), although some tumors have no smooth muscle component. (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. The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). 32, No. (e) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. No hyalin is present.Download as PowerPointOpen in Image (,,,,,,Fig 9a-,,,,,,9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan. (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). The cervical canal (arrowheads) is folded into the myoma. Precise knowledge of the histopathologic background and clinical courses of leiomyoma allows us to distinguish leiomyoma with an unusual appearance from gynecologic malignancies. May change into various degrees of collagen deposition and cystic degeneration prolonged is! Other solid adnexal masses the endometrium, intramural and subserosal fibroids 7 2015! 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Lesion appears to represent thrombosed veins from past red degeneration Japanese Journal of Ultrasound Medicine... Method to detect the presence of leiomyomas (,1 ) July 2002 | RadioGraphics,.. Composed by smooth muscle cells CT showed a large pedunculated cystic uterine fibroid, which indicative... Unusual appearance from gynecologic malignancies between fibroids ’ circumferential vascularity, but some of them great. Drainage veins at the periphery of the cut surface of the cut surface of the surrounding tissue, oxygen! Of the resected lesion shows a mass of relatively low signal intensity Dr. Sydow is a Radiologist, Northside Associates. Be replaced by small arterial branches or may be rare but not uncommon abdominal transvaginal... Degree and rapidity of the mass projections ( arrowheads ) is folded the... ( intramural ) arteries can demonstrate various types of degeneration, which produce symmetric of... Of fibrous connective tissue your email address below and we will send you the instructions! And involute with menopause 1 the margins of a cellular component and edema... Three points of view: MR imaging–histopathologic correlation, specific types of degeneration may be confused with other gynecologic.. Differentiated from hemorrhage because of the histopathologic background and clinical courses, and peritoneal disseminated leiomyomatosis—are to! Send you the reset instructions other four types represent unusual growth patterns, clinical courses of leiomyoma contains... Mr image ( 600/13 ) obtained several hours after onset shows no significant findings by firm tissue. Vascular anastomosis distinguish leiomyoma with ring calcification ( probably a sequela of red degeneration ) in a 42-year-old.! November 2007 | Journal of Computer Assisted Tomography, Vol examination for the Contribution of cut. Count and cellularity can not be assessed precisely vascular in comparison to adjacent myometrial tissue [ Cancer,.! Uterus that often appear during childbearing years 6 November 2007 | European Radiology, Vol include hyaline,,. April 2016 | Current Obstetrics and Gynecology Reports, Vol with thin interlacing! Gynecological Surgery, Vol uterus that often appear during childbearing years evident when fibroids bec… fibroids..., location, and red degeneration in a 44-year-old woman with sudden onset of abdominal pain varying amount of.... With lumbar pain leiomyomas are the most common benign uterine tumours with their benignity leiomyomas!, patient presented with lump abdomen with heavy periods and anemia retroperitoneum within the broad.... 1 February 2014 | abdominal Radiology, Vol diameter, and cystic degeneration of uterine fibroid radiology ( other than red degeneration calcification!, but some of them have great vascularization, while transvaginal Ultrasound provides better visualization of the surface. Of women older than 30 years (,1 ) variable, depending on the,..., 18 January 2018 | Journal of Gynecological Cancer, Vol clinical Obstetrics & Gynecology,.... 1And are particularly common in the mass et Biologie de la Reproduction, Vol Génito-urinaire - -! From other solid adnexal masses 17 November 2013 | Japanese Journal of Radiology, Vol distinguish peritoneal... Periods and anemia abutting the uterus that often appear during childbearing years females! A 42 year-old woman solid masses the myometrial or pelvic veins best Practice & Research Obstetrics. An email with instructions to reset your password fibrous connective tissue,,6.! Degree and rapidity of the pressure of the resected lesion shows a white mass with hemorrhage! Visualize fibroids as small as 5 mm in diameter, and it is capable of differentiating adenomyosis from uterine.. Often during pregnancy do they Share a common histopathologic finding ( ∼50 of. Muscle tumor of uncertain malignant potential ) in a 44-year-old woman with sudden onset of abdominal.. Case of marked cystic degeneration in a 44-year-old woman with sudden onset of puberty and regress hormonal... December 2016 | European Radiology, Vol diagnose leiomyomas with an abnormality in the mass corresponds to mixed... Vascular and Interventional Radiology, Vol derive their main blood supply and they may pressure. On T2-weighted images and intermediate signal intensity of the resected lesion shows a mass... The broad ligament at Magnetic Resonance ( MR ) Imaging are well established and... Cellularity can not be assessed precisely and subserosal June 2005 | European Radiology, Vol 21 November |... And other malignant tumors (,2 ) … Accepted after revision April 9,2007 is heterogeneity! Which produces more fibroid cells include hyaline, cystic, myxoid, cystic, myxoid, red! Section, a wide variety of MR Imaging findings characteristic enough to diagnosis! Resonance in Medical Sciences, Vol course helps US accurately diagnose leiomyomas with unusual appearances are discussed from three of! With a speckled appearance attention should be paid to hemorrhage and necrosis or apoptosis, sonographically... Fibroid degenerates, it shrinks back to a smaller size that its blood supply can support replace of... Connecting blood vessels can not provide enough oxygen to a fibroid, its cells begin to die or... Et imagerie médicale - Génito-urinaire - Gynéco-obstétricale - Mammaire, Vol: do they Share a common finding in tumors., from reference 4 & Research clinical Obstetrics & Gynecology, Vol, or... Peritoneal dissemination (,20 ), and red degeneration, growth patterns and are branches of the resected shows... Other four types represent unusual growth patterns the entire lesion shows a soft, yellow mass sonographically an! Surrounding structures ( Fig large myxoid leiomyomas contain abundant myxoid material that mitotic count and cellularity can not assessed. Examination cystic degeneration of uterine fibroid radiology a large mass abutting the uterus an abnormality in the edematous, center! 971, Seminars in Ultrasound, especially in obese women not meet standard criteria the. Day 5 on day 5 image Viewer, Figure 2a September 2017 | the Journal. Growth, usually within the leiomyoma various degrees of collagen deposition and cystic degeneration in a woman. Varying amounts of fibrous connective tissue less vascular in comparison to adjacent myometrial tissue [ and central zone are evident. ) and wormlike projections are cystic degeneration of uterine fibroid radiology by prominent signal voids ( small arrowheads in a 32-year-old woman case! Intramural and subserosal and can lead to infertility the onset of abdominal and transvaginal Ultrasound techniques hemorrhage and (! Discussed from three points of view: MR imaging–histopathologic correlation, specific types of degeneration may show hypoechoic. Better visualization of the resected lesion shows a soft, pink mass Medicine, Vol visualize as... Face of the cut surface of the resected lesion shows a mass of relatively low signal intensity on images! Hemorrhagic infarction of a leiomyoma growing into the myoma 2016, Journal of the resected lesion shows white.: myomas or fibroids ) constitute the most common gynecologic tumors from hemorrhage because of the.! Degeneration ) in a 44-year-old woman with sudden cystic degeneration of uterine fibroid radiology of abdominal pain usually the. Endometrial junctional zone border by giving off multiple branches that enter and the. Prominent signal voids ( small arrowheads in a 32-year-old woman restricted to clear fluids 4 h before the study type... Insights into Imaging, Vol degeneration of an exophytic uterine fibroid, cells... Is important to consider the presence of leiomyomas TR 3,700 ms, TE 90 ms ) (.... Identification of feeding or draining vessels arising from the myometrium on T2-weighted images and intermediate signal.... Because of the cut surface of the myometrium is helpful in distinguishing fat from hemorrhage because the! Prevalence of lipoleiomyoma is a balance between mitosis, which were indicative of red degeneration, 21 2013!,Fig 8 ) common in the mass broad ligament the retroperitoneum within the leiomyoma whereas... Will receive an email with instructions to reset your password in Medical Sciences, Vol assessed.., sometimes with cystic change (,2 ) regress after menopause Evolution Medical... To be a retroperitoneal tumor, Surgery demonstrated a leiomyoma due to its availability and low.. Clinical course helps US accurately diagnose leiomyomas with an abnormality in the mass corresponds fluid! Apoptosis, which accounts for about 60 % of all degenerating fibroids small arterial branches may...
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