Figure 10b. Viewer. (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. (d) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows nuclear atypia. Figure 4b. Although the lesion appears to be a retroperitoneal tumor, surgery demonstrated a leiomyoma growing into the retroperitoneum within the broad ligament. (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. (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. (f,g)Permission to reprint these figures electronically was denied by the publisher. (c) Diagram shows the relationships between the mass (M), cervical canal (*), and uterus (u). 54, No. See print version.Download as PowerPointOpen in Image 25, 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. Typical leiomyoma in a 37-year-old woman. (,,,,,,Fig 9a-,,,,,,9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan. Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. 3, European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol. (c) Diagram shows the relationships between the mass (M), cervical canal (*), and uterus (u).Download as PowerPointOpen in Image 15, No. Non-contrast-enhanced coronal reformatted CT scan of the abdomen on right demonstrates a large pelvic mass comprised of a large fibroid (white arrow), with some areas of degeneration (red arrows). The lesions are soft and translucent but solid. 27, 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). 9, No. (f,g)Permission to reprint these figures electronically was denied by the publisher. Sagittal T2-weighted image (TR 4,400 ms, TE 90 ms) shows an intramural heterogeneous intermediate signal intensity fibroid, which is probably the cause of abnormal uterine bleeding. Figure 4b. These characteristic signal intensities are attributed to extensive hyalinization, which occurs in more than 60% of uterine leiomyomas (,1,,5,,6). Viewer. Uterine Leiomyosarcoma: Can MRI Differentiate Leiomyosarcoma From Benign Leiomyoma Before Treatment? (c) Photomicrograph (original magnification, ×100; hematoxylin-eosin stain) shows hyaline degeneration throughout the lesion (*). Transvaginal ultrasound provides better visualization of the endometrium and submucosal leiomyomas than abdominal ultrasound, especially in obese women. Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Figure 11a. Fibroids with hyaline or calcific degeneration are difficult to distinguish from non- degenerated fibroids … (d) Photograph of the cut surface of the resected lesion shows a cystic mass filled with gelatinous material (arrowheads).Download as PowerPointOpen in Image Is fibroid heterogeneity a significant issue for clinicians and researchers? The signal intensity of the mass corresponds to fluid mixed with thin, interlacing tissue of intermediate signal intensity on both images. Unlike other types of degeneration, red degeneration usually causes systemic symptoms. Huge cervical leiomyoma in a 32-year-old woman. Viewer. Cystic degeneration of uterine fibroids can sometimes make them indistinguishable from ovarian masses, particularly if the fibroids are extrauterine in location. Other unusual growth patterns are retroperitoneal growth and parasitic growth. Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. Viewer. The type of degenerative change depends on the degree and rapidity of the onset of the vascular insufficiency. All of these lesions are considered to represent fatty metamorphosis of leiomyoma (,1,,5,,6), although some tumors have no smooth muscle component. Leiomyoma consisting of a cellular component and peripheral edema in a 45-year-old woman. (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. Figure 5a. The differential diagnosis includes a wide range of gynecologic and nongynecologic diseases. A diagnostic dilemma! 971, Seminars in Ultrasound, CT and MRI, Vol. Cystic Fibroids Degeneration Cystic degeneration is not so common type of fibroids degeneration; it affects only 4% of all fibroids … 3, Japanese Journal of Radiological Technology, Vol. 74, No. (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). (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. Viewer. Viewer. The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). Edema may change into various degrees of collagen deposition and cystic degeneration (,6). The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). (e) Photomicrograph (original magnification, ×20; hematoxylin-eosin stain) shows sparse smooth muscle cells (arrows) scattered within an area of extensive edema (*). The cervical canal (arrowheads) is folded into the myoma. Viewer. 27, No. 1, No. 19, No. 3, 1 February 2014 | Radiology, Vol. Viewer. Smooth muscle cells are so widely separated by abundant myxoid material that mitotic count and cellularity cannot be assessed precisely. 4, American Journal of Roentgenology, Vol. Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. A subserosal cystic fibroid at the uterine cornu may sometimes be difficult to distinguish from an interstitial ectopic pregnancy (Fig. (c) Diagram shows the relationships between the mass (M), cervical canal (*), and uterus (u).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. Leiomyomas usually grow into the peritoneal cavity. Intravenous leiomyomatosis, metastasizing leiomyoma, diffuse leiomyomatosis, and peritoneal disseminated leiomyomatosis represent unusual growth patterns; other unusual growth patterns are retroperitoneal growth, parasitic growth, and the pattern that may occur in cervical leiomyoma. 24, No. Lipoleiomyoma in a 76-year-old woman. The wormlike projections are accompanied by prominent signal voids (small arrowheads in a). These include lipoleiomyoma, myxoid leiomyoma, intravenous leiomyomatosis, metastasizing leiomyoma, diffuse leiomyomatosis, and peritoneal disseminated leiomyomatosis (,1,,2). Uterine fibroids are classified according to their location as submucosal, ... of degeneration include hyaline, myxoid, cystic and red degeneration. 23, No. 3, Seminars in Ultrasound, CT and MRI, Vol. Because of the pressure of the surrounding tissue, the lesion tends to have an irregular rather than rounded configuration. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. Figure 4d. The reported prevalence of lipoleiomyoma is 0.8% (,14). Can a T2 hyperintense rim sign differentiate uterine leiomyomas from other solid adnexal masses? Viewer. (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. 20, No. Figure 4c. 19, 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). Figure 6c. MRI features of a unilateral ovarian mass of T2 low signal with central areas of edema / cystic degeneration and heterogeneous enhancement in middle-aged women suggest probably an ovarian fibroma. It can occur in pregnancy and non-pregnant state in the reproductive age. Figure 13a. 1, The Kurume Medical Journal, Vol. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. Our MR images are obtained with a 1.5-T Philips Insignia (Philips Healthcare) using a torso phased-array coil. 36, No. Cystic degeneration may be considered as an extreme sequel of edema, and it is reportedly observed in approximately 4% of all uterine leiomyomas [7, 10]. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. 27, No. degeneration is an ischemic change that is most commonly observed during pregnancy. A little sessile subserosal fibroid on the superior face of the uterus (, Pedunculated subserosal fibroids. The cervical canal (arrowheads) is folded into the myoma. 46, No. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. The patient had experienced acute abdominal symptoms during her last pregnancy, which were indicative of red degeneration. Figure 6b. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. (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. (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. Figure 14a. Leiomyoma with extensive edema in a 25-year-old woman. 81, No. Usually not: "cystic degeneration" usually means that a portion of the tumor has died as a result of its blood supply not always being adequate. (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). ), Figure 9b. (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. A tumor with extensive myxoid change may be diagnosed as myxoid leiomyoma, which is discussed later in this article (,1,,2). 80, No. Viewer. (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. Leiomyomas occur more frequently in the body of the uterus (95 % of cases) (Fig. 5, European Journal of Radiology, Vol. 8, Journal of Computer Assisted Tomography, Vol. 29, No. Leiomyoma with extensive edema in a 25-year-old woman. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/9) show irregular areas of necrosis (arrows). Diffuse leiomyomatosis involves development of innumerable small leiomyomas, which produce symmetric enlargement of the uterus. The cut surface has a characteristic whorl-like, trabeculated appearance, by whitish to reddish color according to the prevalence of fibrous connective tissue or the prevalence of smooth muscle cells. (b) Photograph of the cut surface of the resected lesion shows a white mass with a speckled appearance. Figure 11c. (c) Photograph of the resected specimen shows the subserosal tumor (arrows) and wormlike projections (arrowheads).Download as PowerPointOpen in Image The patient had experienced acute abdominal symptoms during her last pregnancy, which were indicative of red degeneration. (a) Sagittal fast spin-echo T2-weighted MR image (6,000/126) shows a mass of relatively low signal intensity. Extremely prevalent, they occur in more than 20% of women older than 30 years (,1,,2). Subserosal leiomyoma with extensive cystic degeneration in a 61-year-old woman. Cystic degeneration may be considered an extreme sequela of edema and is observed in about 4% of leiomyomas (,1). Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). No hyalin is present.Download as PowerPointOpen in Image (c) Photograph of the cut surface of the resected lesion shows an almost entirely cystic mass with scanty solid tissue. 15, No. Only about 50 cases of peritoneal disseminated leiomyomatosis have been reported (,19). We have encountered several cases of cervical leiomyomas with an unusual growth pattern. Thus, attention should be paid to hemorrhage and necrosis as clues in the diagnosis of sarcoma. At microscopy, fluid is seen in the stroma of the leiomyoma, often in association with collagen. Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. (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. (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). ), Figure 9d. ), Figure 3a. 9, © 2021 Radiological Society of North America, https://doi.org/10.1148/radiographics.19.suppl_1.g99oc04s131, Open in Image Figure 14b. )Download as PowerPointOpen in Image 20, No. Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-year-old woman. (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows). The most common type of degeneration is focal or generalized hyalinization. (Reprinted, with permission, from reference 4. Figure 8a. (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. Because leiomyomas are the most common gynecologic tumors and are exclusively benign, it is important to be familiar with the variety of MR imaging appearances of uterine leiomyomas to distinguish them from other significant diseases. Leiomyoma with extensive edema in a 25-year-old woman. 4, 1 September 2004 | RadioGraphics, Vol. Viewer. Figure 6a. (c) Diagram shows the relationships between the mass (M), cervical canal (*), and uterus (u). (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows). 4, 18 April 2012 | Insights into Imaging, Vol. Viewer. (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. 33, No. Imaging. 1, 30 May 2013 | Japanese Journal of 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. (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). 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. No hyalin is present.Download as PowerPointOpen in Image At the microscopic level, hyalinization begins in the stromal component that separates the smooth muscle cells and then progresses to extensive replacement of the smooth muscle cells (,2). No hyalin is present. 2, 8 November 2004 | Abdominal Imaging, Vol. 01, American Journal of Roentgenology, Vol. 44, No. (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). Typical appearance of fibroid uterus on CT. Figure 4e. Unusual appearances are discussed from three points of view: MR imaging–histopathologic correlation, specific types of unusual leiomyomas, and unusual growth patterns. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/9) show irregular areas of necrosis (arrows). Myxoid degeneration appears as soft mucoid areas, sometimes with cystic change (,2). To understand the wide spectrum of MR imaging findings, such unusual appearances can be classified into three categories: degeneration and other histopathologic findings, specific types of unusual leiomyomas, and unusual growth patterns. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/9) show irregular areas of necrosis (arrows). See print version. (a) Sagittal fast spin-echo T2-weighted MR image (6,000/126) shows a mass of relatively low signal intensity. (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). Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. 25, No. 3, Journal of Medical Ultrasound, Vol. 26, No. 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). (c) Photomicrograph (original magnification, ×100; hematoxylin-eosin stain) shows hyaline degeneration throughout the lesion (*). 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. It is important to consider peripheral lymphedema in the diagnosis of leiomyoma, whereas central necrosis is a common finding in ovarian tumors. Figure 2a. This report exemplifies how challenging the diagnosis could be with fibroid degeneration. The entire lesion shows no enhancement, which indicates complete interruption of blood flow. The patient is restricted to clear fluids 4 h before the examination and voided immediately before the study. (a) Sagittal fast spin-echo T2-weighted MR image (6,000/126) shows a mass of relatively low signal intensity. 1, 18 September 2015 | Journal of Magnetic Resonance Imaging, Vol. 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. When fibroids bec… (d) Photomicrograph (original magnification, ×200; hematoxylin-eosin stain) shows nuclear atypia. Leiomyoma consisting of a cellular component and peripheral edema in a 45-year-old woman. In this way, cystic fibroids degeneration starts. The damaged smooth muscle will eventually be replaced by firm collagenous tissue (,1). Leiomyoma with ring calcification (probably a sequela of red degeneration) in a 42-year-old woman. (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. Leiomyoma with extensive edema in a 25-year-old woman. 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. 3, No. When a fibroid degenerates, it shrinks back to a smaller size that its blood supply can support. Submucosal and intramural fibroids may also cause infertility, spontaneous abortions, or premature placental abruption. Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). (a, b) Sagittal 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). (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). Cystic degeneration is an extreme sequel of edema. 4, 27 August 2014 | Journal of Magnetic Resonance Imaging, Vol. See print version. 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. 43, No. Fibroids with this type of degeneration may show cystic areas with … Figure 14a. Fluid accumulates for multiple reasons, and edema is a common histopathologic finding, observed in about 50% of leiomyomas. When the connecting blood vessels cannot provide enough oxygen to a fibroid, its cells begin to die, or degenerate. (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). Gynecological Surgery, Vol kills fibroid cells heterogeneous, solid masses original magnification, ×200 ; stain. 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