Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. 68, 28 July 2015 | SpringerPlus, Vol. 15, No. A rarely observed pattern is ringlike calcification at the margins of a leiomyoma (,,,,Fig 8). (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. Viewer. Figure 4g. Many of the reported cases have been associated with pregnancy. (e) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. (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). However, several specific types of leiomyoma—intravenous leiomyomatosis, metastasizing leiomyoma, diffuse leiomyomatosis, and peritoneal disseminated leiomyomatosis—are exceptions to this rule. 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 [. (d) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows nuclear atypia. Benign and malignant tumor of the uterine body with broccoli sign: MR imaging features for differential diagnosis, Volumetric MR-guided high-intensity focused ultrasound ablation of uterine fibroids: treatment speed and factors influencing speed, A Case of Large Uterine Myoma in a 14-Year-Old Girl, MR Imaging in Corpus Neoplasia: Spectrum of MR Findings, Advanced MRI in malignant neoplasms of the uterus, MR Thermometry Analysis of Sonication Accuracy and Safety Margin of Volumetric MR Imaging–guided High-Intensity Focused Ultrasound Ablation of Symptomatic Uterine Fibroids, Volumetric MR-HIFU ablation of uterine fibroids: Role of treatment cell size in the improvement of energy efficiency, T2-Hypointense Adnexal Lesions: An Imaging Algorithm, Radiological appearances of gynaecological emergencies, Retroperitoneal growth of degenerated myxoid uterine leiomyoma mimicking sarcoma, Volumetric MR-guided High-Intensity Focused Ultrasound Ablation with a One-Layer Strategy to Treat Large Uterine Fibroids: Initial Clinical Outcomes, Nontraumatic Abdominal Pain in Pregnancy: Imaging Considerations for a Multiorgan System Problem, Diffuse uterine leiomyomatosis in a child, Uterine Artery Embolization for Symptomatic Fibroids with High Signal Intensity on T2-Weighted MR Imaging, Alternatives thérapeutiques des fibromes hors traitement médicamenteux et embolisation, Dynamic Contrast-Enhanced Magnetic Resonance Imaging Predicts Immediate Therapeutic Response of Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation of Symptomatic Uterine Fibroids, Uncommon Presentation of a Uterine Lipoleiomyoma, Interest of diffusion-weighted echo-planar MR imaging and apparent diffusion coefficient mapping in gynecological malignancies: A review, Value of T2-weighted MR imaging in differentiating low-fat renal angiomyolipomas from other renal tumors, Imaging malignant and apparent malignant transformation of benign gynaecological disease, Radiology of Benign Disorders of Menstruation, MRI appearance of mesenchymal tumors of the uterus, Combined use of T2-weighted and diffusion-weighted 3-T MR imaging for differentiating uterine sarcomas from benign leiomyomas, Hyperintense Uterine Myometrial Masses on T2-Weighted Magnetic Resonance Imaging, Imaging Appearances of Uterine Lipoleiomyoma With Pathological Correlation—Report of Two Cases and Literature Review, Image-Guided Thermal Therapy of Uterine Fibroids, Visualización por resonancia magnética del drenaje venoso en las masas pélvicas: una ayuda para filiar su origen, Role of diffusion-weighted imaging in the diagnosis of gynecological diseases, AJR The cystic spaces appear as round, well-demarcated areas with the signal intensity characteristic of fluid: low on T1-weighted images and high on T2-weighted images with no enhancement (,,,,Fig 2). The cervical canal (arrowheads) is folded into the myoma. The signal intensity of the mass corresponds to fluid mixed with thin, interlacing tissue of intermediate signal intensity on both images. 51, Taiwanese Journal of Obstetrics and Gynecology, Vol. 270, No. Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Viewer. Submucosal and intramural fibroids may also cause infertility, spontaneous abortions, or premature placental abruption. An unusual growth pattern may also occur in cervical leiomyoma. With extensive edema, the entire lesion has high signal intensity on T2-weighted images and demonstrates marked enhancement (,11) (,,,,,,Fig 6). (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, Journal of the Korean Society of Radiology, Vol. (c) Photograph of the resected specimen shows the subserosal tumor (arrows) and wormlike projections (arrowheads). Figure 10d. Smooth muscle cells are so widely separated by abundant myxoid material that mitotic count and cellularity cannot be assessed precisely. (f,g)Permission to reprint these figures electronically was denied by the publisher. Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. Degeneration occurs primarily in large leiomyomas and causes an increase of the symptoms or the onset of new symptoms (abdominal pain, menorrhagia, and bulk-related symptoms such as pelvic heaviness, palpable mass, urinary urgency, constipation, and bowel obstruction). (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. Figure 6b. Subserosal leiomyoma with extensive cystic degeneration in a 61-year-old woman. The wormlike projections are accompanied by prominent signal voids (small arrowheads in a). (e) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. 5, Seminars in Ultrasound, CT and MRI, Vol. Unusual appearances are discussed from three points of view: MR imaging–histopathologic correlation, specific types of unusual leiomyomas, and unusual growth patterns. The presence of edema strongly affects the signal intensity of leiomyomas and may antedate hyalinization and cystic degeneration (,1,,5,,6). Figure 14a. 5, Best Practice & Research Clinical Obstetrics & Gynaecology, Vol. (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). 10, No. (e) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. Ultrasonography is often the first method to detect the presence of leiomyomas due to its availability and low cost. Figure 10b. Dr. Sydow is a Radiologist, Northside Radiology Associates, Atlanta, GA. Cystic Fibroids Degeneration Cystic degeneration is not so common type of fibroids degeneration; it affects only 4% of all fibroids … Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. Leiomyoma with extensive edema in a 25-year-old woman. Can a T2 hyperintense rim sign differentiate uterine leiomyomas from other solid adnexal masses? (c) Photograph of the cut surface of the resected lesion shows an almost entirely cystic mass with scanty solid tissue. 6, 5 March 2018 | Journal of Magnetic Resonance Imaging, Vol. 3, American Journal of Roentgenology, Vol. Other unusual growth patterns are retroperitoneal growth and parasitic growth. T1 Enter your email address below and we will send you the reset instructions. 6, Gynecologic Oncology Case Reports, Vol. Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-year-old woman. 24, No. Figure 4b. 3, 27 April 2007 | Radiation Medicine, Vol. 77, No. The patient had experienced acute abdominal symptoms during her last pregnancy, which were indicative of red degeneration. (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. See print version. Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. (a) Sagittal fast spin-echo T2-weighted MR image (6,000/126) shows a mass of relatively low signal intensity. The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). 28, No. Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. ), Figure 10a. ! (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). 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). (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. 3, Journal of Computer Assisted Tomography, Vol. However, leiomyomas can demonstrate various histopathologic patterns of degeneration, some of which alter the MR imaging appearance. Figure 8b. correction, Uterine fibroids: correlations between MRI appearance and stiffness via magnetic resonance elastography, CT features for diagnosing acute torsion of uterine subserosal leiomyoma, Uterine smooth muscle tumours with hyperintense area on Figure 4d. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. (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. 211, No. 1, CardioVascular and Interventional Radiology, 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). Secondary calcification occurs in hyalinized tissue in about 4% of leiomyomas (,1). Figure 1b. (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). 1, 18 September 2015 | Journal of Magnetic Resonance Imaging, Vol. If the fibroids aggressively grow, they can degenerate, causing significant pain to the patient. Subserosal leiomyoma with hyaline and cystic degeneration in a 42 year-old woman. Hemorrhage and necrosis are not obvious. We thank Fumie Ametani, MD, Tsuyoshi Itoh, MD, Tadashi Sagoh, MD, Masato Noguchi, MD, and the members of the Department of Obstetrics and Gynecology, Kyoto University, for their sincere cooperation. Leiomyoma with extensive edema in a 25-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). The patient had experienced acute abdominal symptoms during her last pregnancy, which were indicative of red degeneration. Hemorrhage and necrosis are not obvious. 1, 24 November 2006 | Radiation Medicine, Vol. A tumor with extensive myxoid change may be diagnosed as myxoid leiomyoma, which is discussed later in this article (,1,,2). (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). 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). Figure 7c. Being rare in prepubertal females, they commonly accelerate in growth during pregnancy and involute with menopause 1. 18.14), if the intrauterine pregnancy is not found. Leiomyomas are by far the most common uterine tumors and the most common gynecologic tumors. See print version.Download as PowerPointOpen in Image Although histologically benign, these leiomyomas grow into veins, metastasize to distant organs, diffuse throughout the uterine parenchyma, or disseminate throughout the peritoneal cavity. Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-year-old woman. 11, 27 June 2012 | RadioGraphics, Vol. 6, 1 September 2003 | Journal of Ultrasound in Medicine, Vol. Viewer. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. Is fibroid heterogeneity a significant issue for clinicians and researchers? 9, No. Viewer. Cystic degeneration of uterine fibroids can sometimes make them indistinguishable from ovarian masses, particularly if the fibroids are extrauterine in location. 26, No. 6, 28 May 2014 | Veterinary Radiology & Ultrasound, Vol. Viewer. 46, No. At US, leiomyomas typically appear as symmetrical, well-defined, heterogeneous, solid masses. Degenerative fibroids may have a complex appearance. Uterine fibroids occur during the reproductive years. Figure 6d. 1, 28 June 2011 | Pediatric Radiology, Vol. (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 6c. 24, 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). Viewer. 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). 4, 1 January 2007 | Journal of Magnetic Resonance Imaging, Vol. 33, No. Figure 10b. (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). Fig. Patient with abnormal uterine bleeding. Figure 11b. (e) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. (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. Viewer. 3, European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. Figure 7d. 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