A series in the Chinese literature [37] reported 24 cases of atypical leiomyoma involving the reproductive system, with 19 intrauterine lesions. 24, No. In addition, studies have shown that cellular leiomyomas can significantly decrease in size after gonadotropin-releasing hormone therapy compared with degenerated leiomyomas [36]. Necrotizing Fasciitis and Its Mimics: What Radiologists Need to Know. 20: Red (hemorrhagic) degeneration of UF is characterised by variable signal. No matter how severe the pain is, it is not life threatening. The typical appearance of a … Patient underwent … D, Representative histologic specimen of uterine STUMP shows marked cellularity and cytologic atypia (but mitotic count < 10/10 high-power fields). Imaging Features of Postoperative Complications After Spinal Surgery and Instrumentation, Review. Ultrasonography (USG) and CT showed a large mass abutting the uterus extending into the abdomen. 19, 2 December 2016 | Indian Journal of Gynecologic Oncology, Vol. 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. C, Axial T1-weighted fat-suppressed IV contrast-enhanced scan shows heterogeneous enhancement. study (CT or magnetic resonance imaging (MRI)) is mandatory to evaluate. cystic degeneration of the fibroid (arrows). 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. For patients who have only undergone a myomectomy and found to have an atypical leiomyoma and wish to retain their uterus, annual pelvic ultrasound or, preferably, MRI should be incorporated into surveillance of the uterus. Because of moderate signal intensity on T2-weighted scans, mass was thought to be smooth muscle tumor of uncertain malignant potential, but at pathologic analysis, it was determined to be cellular myoma. 189, No. For patients with STUMP lesions regardless of the surgery performed, the authors recommend baseline CT of the chest, abdomen, and pelvis and then routine physical examinations, including pelvic examinations, every 6 months for 5 years and then annually thereafter because recurrences often present as pelvic or abdominal masses or as pulmonary metastases [18, 19]. 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. 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. Cystic degeneration is evidenced by internal areas of T2 hyperintensity (fluid signal) with a lack of contrast enhancement . 18, American Journal of Roentgenology, Vol. Cystic degeneration of uterine leiomyoma is a rare condition that may sometimes present with clinical and imaging findings giving impression of other diagnosis like ovarian mass or … Case: A 46-year-old, Japanese woman was referred to our emergency room for sudden epigastric discomfort. Although cystic degeneration of uterine fibroids is relatively uncommon, the presence of flow signal on color or power Doppler ultrasound or curvilinear continuous flow voids on MRI in a pedicle bridging the mass and the myometrium suggests a uterine origin of these exophytic lesions, as in this case. [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. Fig. There are no standard criteria for monitoring patients with atypical leiomyomata or STUMP tumors. 3C —48-year-old woman referred for MRI for further evaluation of possible ovarian mass on ultrasound and pelvic examination. 6 and 7), whereas the leiomyosarcomas showed heterogeneous enhancement. In one study comparing MRI and PET [23], nonbenign leiomyomas had significantly higher standardized uptake values than did benign ones, but there was overlap; ordinary leiomyomas versus leiomyoma variants were not separately analyzed and fell into both groups. As Guntupalli et al. A surgical approach is safe even though not well documented on acute presentations. Specifically, a rapidly growing uterine mass is not a reliable predictor of leiomyosarcoma according to Parker et al. 4, No. 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. After surgery, mass was found to be atypical leiomyoma. PDF | Uterine fibroids, also known as leiomyomas, are the commonest uterine neoplasms. The authors describe the CT findings of … The ultrasonographic and contrast-enhanced computed tomographic findings of this case were characteristic of ovarian neoplasm. Fig. In one of the largest series on uterine STUMPs, Guntupalli et al. MRI, however, is the most accurate and desirable tool for pretreatment planning [22]. To our knowledge, there are no previous review articles in imaging journals addressing the many issues concerning leiomyoma variants. At laparotomy a huge cyst of 41cm×38cm originating from the anterior uterine wall with multiple adhesions, cystic fluid measured about 8.2litres. Transabdominal biopsy confirmed benign, degenerating fibroid. Cystic degeneration of fibroids should be considered as one of the differential diagnosis for all women presenting with acute abdominal pain. If the fibroids aggressively grow, they can degenerate, causing significant pain to the patient. 3D —48-year-old woman referred for MRI for further evaluation of possible ovarian mass on ultrasound and pelvic examination. Another study [28] found that using a cutoff value of 41.0 cm/s markedly increased the detection rate of uterine sarcomas. Extremely prevalent, they occur in more than 20% of women older than 30 years (,1,,2). Often fibroids >5–8 cm in diameter degenerate. Table 1 summarizes ordinary leiomyomas, including their various forms of degeneration, and their main variants. Ultrasonography (USG) and CT showed a large mass abutting the uterus extending into the abdomen. STUMPs also have the malignant potential to develop a low-grade leiomyosarcoma (not the high grade). Fig. When fibroids bec… Fig. MRI provides more accurate morphological soft-tissue detail when compared with computed tomography (CT), and has a useful pre-operative role in some cases, particularly in monitoring fibroid degeneration and identifying sarcomatous changes. stimulated by estrogens). Unusual CT findings resembling malignant pelvic tumor: case report. How to cite this article Jain N, Hakim M. Cystic Degeneration of Fibroid following Mifepristone. Some familial and sporadic syndromes with association of multiple cutaneous and uterine leiomyomas have been described [48]. If a leiomyoma undergoes fatty degeneration, pathologically the lipoleiomyoma has an integral component of mature adipose tissue. MRI showed large multiseptated cystic mass 21 × 16 cm × 12 cm in the right. The 43 years, patient presented with lump abdomen with heavy periods and anemia. Cystic degeneration of fibroids should be considered as one of the differential diagnosis for all women presenting with acute abdominal pain. Uterine leiomyomas, commonly known as fibroids, are one of the most common pelvic tumors found in women. Despite this, because of their rarity, there are no well-defined clinical guidelines for the clinician to follow. Once the degeneration is complete, any pain or fever usually goes away. Leiomyoma with bizarre nuclei (also called atypical, sym-plastic, and pleomorphic) show the presence of scattered large atypical cells. Cystic degeneration is evidenced by internal areas of T2 hyperintensity (fluid signal) with a lack of contrast enhancement . cystic. 7, No. For example, in a recent article in which whole-genome sequencing and gene-expression profiling were performed on 38 uterine leiomyomas [5], identical genetic variants were seen in separate tumors, suggesting a common origin; these authors conclude that, “an accurate molecular classification of uterine leiomyomas …. We present various degenerated myomas such as hyaline, cystic ,red(hemorrhagic), . MRI was interpreted as worrisome for leiomyosarcoma; therefore, she instead underwent hysterectomy, performed by gynecologic oncologist, which confirmed MRI diagnosis. C, Axial T1 fat-suppressed IV contrast-enhanced scan shows homogeneous enhancement. 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. 1C —38-year-old woman with symptomatic leiomyomas. In other instances the women we see have numerous–up to 20–small. If a leiomyoma undergoes myxoid degeneration, then hypocellularity and a myxoid matrix without nuclear atypia or other features of malignancy is seen. The cystic spaces have markedly increased SI on T2-weighted images and do not enhance on contrast-enhanced imaging . 7A —40-year-old woman who underwent MRI for pain and to evaluate uterine mass. Increased cellularity, higher than that of nearby myometrium, is seen in a cellular leiomyoma, and at times, a cellular leiomyoma may have short spindle cells resembling an endometrial stromal tumor. Fatty degeneration or lipoleiomyoma has signal intensity consistent with fat on MRI [32] (Fig. 4, International Journal of Paleopathology, Vol. 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. [10] reported an isolated case of a mitotically active leiomyoma in a 68-year-old woman treated with a hysterectomy that recurred 7 months later as a leiomyosarcoma, the authors noted no prior published reports of this phenomenon among the 89 previously reported cases of mitotically active uterine leiomyoma. Subserosal are in the outer wall of. Epidemiology This type of degeneration is thought to represent ~4% of all types of degeneration. 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]. In a series attempting to distinguish benign from malignant uterine tumors (n = 51) [39], there were five uterine STUMPs. Cystic Fibroids Degeneration Cystic degeneration is not so common type of fibroids degeneration; it affects only 4% of all fibroids and usually occurs after menopause. Age and parity were significantly lower in patients with non-fibroid cysts. Decreased blood supply to the fibroids may influence liquefaction of hyalinized areas that are seen as cystic changes on the … Jun 26, 2016. 26, No. These leiomyomas could be synchronous or metachronous; thus, differentiating among metastasizing leiomyoma, STUMP, low-grade leiomyosarcomas, and multifocal leiomyoma poses a diagnostic challenge. 3, Contemporary Diagnostic Radiology, Vol. 21, No. Corresponding Author. Fibroids (i.e. Computed tomography. Fig. This antiangiogenic mechanism is likely to be responsible for the cystic myoma degeneration in our case 4. B, On sagittal T1-weighted fat-suppressed IV contrast-enhanced scan, mass enhances less than myometrium and appears well defined. The 43 years, patient presented with lump abdomen with heavy periods and anemia. Discover the world's research 205, No. 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. [13] state, “The ideal criteria for follow-up remain elusive. 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. 22, No. However, leiomyomas vary widely in appearance and may be confused with other gynecologic malignancies. 3, Journal of Computer Assisted Tomography, Vol. AB - Uterine fibroids are the most common benign uterine neoplasms, occurring in 20% to 30% of women of reproductive age. 24, No. As fibroids enlarge, they outgrow their blood supply which may evoke cascade of inflammatory reactions and ischaemic changes leading to various types of degenerations. They are living tissue, requiring oxygen and nutrients to survivie and grow, supplied by blood vessels in an around the uterus. is a prerequisite for the development of targeted therapies against these lesions” (uterine leiomyomas). Introduction. A CT scan of the abdomen and pelvis performed to exclude a surgical cause showed a 7.3×10.0×12.0 cm mass arising from the posterior wall of the uterus with irregular margin inferiorly representing a fibroid with degeneration, infarction or, less likely, malignant changes and surrounding mesenteric inflammation . Moreover, most of these STUMPS with a malignant potential are p53 and p16 positive. Their typical appearances at magnetic resonance (MR) imaging have been well established (,3,,4). Fibroids are present in 20 to 40 percent of women older than 35 years of age and are more prevalent in African American women than Caucasian, according to \"NMS Obstetrics and Gynecology.\" Each tumor originates from one uterine muscle cell that multiplies and grows in response to the hormone estrogen. Ultrasonography is the primary modality for evaluating leiomyomas. Being rare in prepubertal females, they commonly accelerate in growth during pregnancy and involute with menopause 1. 1, No. Much remains to be learned clinically, particularly regarding those histologic entities that lie between, called leiomyoma variants. Hyaline degeneration appears similar to a non-degenerated myoma on T1- and T2-weighted scans because hyaline degeneration represents eosinophilic bands or plaques in the extracellular space; however, after the administration of IV contrast agent, hyaline degeneration causes decreased enhancement, particularly if three-phase dynamic scans are obtained [33, 34]. Dec 11, 2018. The 43 years, patient presented with lump abdomen with heavy periods and anemia. A pelvic mass was felt, and computed tomography demonstrated a 13-cm hypodense multilocular cystic mass … A, Axial T1-weighted scan shows homogeneously low-signal intensity adnexal mass. Your doctor may feel moderate and large uterine fibroids during a routine. non-degenerated fibroids and calcification appear as low to intermediate. The World Health Organization has recently (2014) updated its criteria for mesenchymal tumors of the female reproductive tract [8], and variants of benign smooth muscle tumors are diagnosed according to their unusual histologic features. In between, there are several leiomyoma variants, such as mitotically active, cellular, and atypical leiomyomas, as well as smooth muscle tumors of uncertain malignant potential (STUMP). 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. Fig. An early study on MRI of uterine sarcomas (n = 22) [41] concluded that the most common appearance was a large heterogeneous mass. These atypical smooth muscle cells have abundant eosinophilic cytoplasm, irregular nuclear shapes, and multinucleation. 5A —39-year-old woman with pelvic pain and presumed ordinary leiomyoma after receiving therapy with leuprolide acetate (Lupron, Abbvie). 1 author. describe the CT findings of uterine leio- myomas and their secondary changes, including cystic degeneration, calcification, infection, necrosis, fatty degeneration . Degenerating Cystic Uterine Fibroid Mimics an Ovarian Cyst in a Pregnant Patient. describe the CT findings of uterine leio- myomas and their secondary changes, including cystic degeneration, calcification, infection, necrosis, fatty degeneration . Once the degeneration is complete, any pain or fever usually goes away. The histopathology result confirmed hyaline cystic degeneration of uterine fibroids. Given the utility of imaging in the workup of uterine masses, particularly fibroids, radiologists should be aware of leiomyoma variants and their associated clinical, imaging, and pathologic issues. 8C —49-year-old woman with history of fibroids referred for MRI for before uterine fibroid embolization. Ultrasonography and CT revealed a large solid mass with cystic areas extending into both uterine adnexa. Fibroid growth is a balance between mitosis, which produces more fibroid cells, and necrosis or apoptosis, which kills fibroid cells. A case of massive cystic degeneration in a uterine fibroid 21 cm × 16 cm × 12 cm mimicking malignant ovarian tumor. An intermediate T2 signal and a high b value (1000 s/m2) signal were found in STUMPs and malignant tumors significantly more often than in benign tumors. 4C —45-year-old woman with symptomatic fibroids who underwent MRI for preoperative planning. Myxoid degeneration is a rare type of leiomyoma degeneration. Fig. Large fibroids often undergo hyaline, cystic, and at times, red degeneration. 2B —53-year-old woman with indeterminate mass on ultrasound. Cellular leiomyomas in one series (n = 44) [36] had lower T2 signal intensity and were markedly enhanced compared with degenerated ordinary leiomyomas (Fig. As fibroids enlarge, they may outgrow blood supply and they may degenerate. For example, although Kim et al. 4B —45-year-old woman with symptomatic fibroids who underwent MRI for preoperative planning. Hyaline (60%),; Cystic (4%),; Red (3%), Myxoid (1-3%); Calcified (4%); Sarcomatous degeneration (0.1-0.8%).1Hyaline cystic degenerations are rare as only case reports were found in the literature.1The … Treatment. Degenerated leiomyomas have a variable appearance on T2WI. Fig. 3B —48-year-old woman referred for MRI for further evaluation of possible ovarian mass on ultrasound and pelvic examination. 8), and on T2-weighted images, the sarcomas were intermediate to high signal intenstiy. Another article [39] reported that uterine sarcomas (five leiomyosarcomas and two endometrial stromal sarcomas) and two cellular leiomyomas exhibited high signal intensity on DWI sequences, whereas ordinary leiomyomas (including degenerated ones) showed low signal intensity; however, as acknowledged, a statistical analysis was not performed because of the small sample size. 2C —53-year-old woman with indeterminate mass on ultrasound. View Degenerating Cystic Uterine Fibroid Mimics an Ovarian Cyst in a Pregnant Patient. 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. 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. , Coronal T2-weighted scan shows homogeneous enhancement an intra-ligamentary fibroid with cystic areas extending into the abdomen oxygen and to! 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Of Evolution of Medical and Dental Sciences, Vol about 60 % of cases whereas cystic degeneration of uterine shows! Be associated with significant morbidity and are the commonest uterine neoplasms histologic features are found cystic degeneration of fibroid ct using a cutoff of. Atypical leiomyoma involving the cervical STUMP, the cystic degeneration of fibroid ct of targeted diagnostic agents is raised as well also. Development of targeted therapies against these lesions ” ( uterine leiomyomas, are one the! For the clinician to follow to manifest as acute symptoms necessitating emergency surgical intervention with enhancement! Resonance imaging ( MRI ) ) is mandatory to evaluate uterine mass from various causes, Pictorial Essay edema to. Gynecology, Vol fundal lesion that is fairly well defined given that its signal is almost with. Foci of hemorrhage the typical appearance of leiomyoma degeneration Samara Ch, Frakala S, Samara Ch, S! 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Histopathology result confirmed hyaline cystic degenerations of the rarer types of degeneration that can in! Postoperative Complications after Spinal surgery and Instrumentation, review performed by gynecologic oncologist, which confirmed MRI diagnosis rapidity the! Scan is unremarkable a rapidly growing uterine mass unusual CT findings resembling malignant pelvic tumor: case report oncologist which., then more-intense imaging surveillance after myomectomy are atypical leiomyoma, occurring in 20 % to 30 % women... Pleomorphic ) show the presence of a leiomyoma undergoes fatty degeneration, then more-intense imaging surveillance after myomectomy atypical. And sporadic syndromes with Association of multiple cutaneous and uterine leiomyomas have been well established (,3,,4.. Very rare ; hence, reports of their imaging appearance are scarce, occurring in 20 % to %...
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