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Dhillon MS, Garg A, Sehgal A, Bhasin S. Torsion of a huge subserosal uterine leiomyoma: A challenging case of acute abdomen. SA J Radiol 2023; 27:2641. [PMID: 37292422 PMCID: PMC10244948 DOI: 10.4102/sajr.v27i1.2641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/22/2023] [Indexed: 06/10/2023] Open
Abstract
Torsion of a uterine leiomyoma is an extremely rare, albeit life-threatening surgical emergency. A 28-year-old woman presented with acute abdominal pain. Imaging revealed a torsed subserosal uterine leiomyoma which was managed surgically and the diagnosis confirmed intraoperatively as well as on histopathology. Contribution While intraoperative findings remain the primary means of diagnosis, radiologists should be familiar with the potential imaging findings of leiomyoma torsion as timely intervention can greatly improve patient outcome.
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Affiliation(s)
- Mankirat S. Dhillon
- Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Apoorva Sehgal
- Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Sangeeta Bhasin
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Drolia B, Gupta N, Verma R, Belho ES, Dhawan S. Follow-up 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Evaluation of a Torsion of Uterine Fibroid in an Elderly Female. Indian J Nucl Med 2020; 35:330-332. [PMID: 33642759 PMCID: PMC7905289 DOI: 10.4103/ijnm.ijnm_104_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/04/2022] Open
Abstract
Fibroids are rare in postmenopausal females. Torsion of pedunculated uterine fibroid is also a very rare occurrence in elderly females. We report a rare case of an 84-year-old multiparous, postmenopausal female, a treated case of non-Hodgkin's lymphoma, presenting with a large abdominal mass. The comparative positron emission tomography/computed tomography scan study of the patient revealed that a new mass in the abdomen and pelvis connected with the left adnexa with a pedicle and previously seen fibroid was not visualized on the present scan, thus raising suspicion of torsion of subserosal fibroid. Histopathology confirmed the diagnosis of fibroid.
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Affiliation(s)
- Babita Drolia
- Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Nitin Gupta
- Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Ritu Verma
- Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Ethel Shangne Belho
- Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Shashi Dhawan
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
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Jha S, Singh A, Singh S, Murmu S. Huge broad ligament leiomyoma with cystic degeneration: A diagnostic and surgical challenge. J Obstet Gynaecol Res 2020; 46:791-794. [PMID: 32043297 DOI: 10.1111/jog.14213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/26/2020] [Indexed: 12/19/2022]
Abstract
Broad ligament is the common extrauterine site for fibroid. We present a case of huge broad ligament fibroid with cystic degeneration. Patient presented with abdominal swelling and mild pain abdomen. On abdominal examination, a large tense cystic mass of 34 weeks gravid uterus size arising from pelvis was noted. Cervix was pulled up and all fornices were full with mass on pelvic examination. Ultrasound suggested adnexal mass as ovaries were not seen. Contrast-enhanced computed tomography abdomen too reported adnexal mass likely of ovarian origin. On laparotomy, 6 L of straw color fluid drained from the mass which was seen arising from left broad ligament, bilateral ovaries were separate from the mass and appeared healthy. Enucleation of mass was done to ease the hysterectomy and careful evaluation of ureteric course was done throughout the surgery to avoid its injury. Total hysterectomy with bilateral salpingo-opherectomy and pelvic lymphadenectomy was performed. This case is being reported for its rare incidence, diagnostic dilemma and surgical challenge.
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Affiliation(s)
- Sangam Jha
- Department of Obstetrics and Gynaecology, AIIMS, Patna, India
| | - Anamika Singh
- Department of Obstetrics and Gynaecology, AIIMS, Patna, India
| | - Samanta Singh
- Department of Obstetrics and Gynaecology, AIIMS, Patna, India
| | - Suhagini Murmu
- Department of Obstetrics and Gynaecology, AIIMS, Patna, India
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Affiliation(s)
- Venkatraman Indiran
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, 7 Works Road, Chromepet, Chennai, Tamilnadu, 600044, India.
| | - J Kokilavani
- VK Clinic, Chromepet, Chennai, Tamilnadu, 600044, India
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Can a T2 hyperintense rim sign differentiate uterine leiomyomas from other solid adnexal masses? ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s00261-015-0510-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
OBJECTIVE Female pelvic masses have a broad differential diagnosis, including benign and malignant neoplasms and nonneoplastic entities. CONCLUSION By using a systematic approach to the evaluation of a complex pelvic mass, including incorporating the clinical and surgical history, and by using multiparametric MRI to identify the anatomic origin, morphologic features, and tissue composition of a mass, a short meaningful differential diagnosis or definitive diagnosis can often be established.
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Naz Masood S, Masood Y, Mathrani J. Diagnostic dilemma in Broad Ligament Leiomyoma with Cystic Degeneration. Pak J Med Sci 2014; 30:452-4. [PMID: 24772162 PMCID: PMC3999029 DOI: 10.12669/pjms.302.4361] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 12/03/2022] Open
Abstract
Fibroids are smooth muscle benign tumors; most commonly arise from uterus but may also rise from extra uterine sites like broad ligament. This case report of broad ligament myoma with extensive cystic degeneration is presented for its rarity and diagnostic challenges as they mimic pelvic adenexal tumors. Mrs. X, 43 years old p5+2, asymptomatic women with no co-morbids presented with mass in abdomen. The MRI showed mix attenuation mass of 19.7 x 16.8 x 13.7cms arising from right side of uterus extending up to epigastrium, with cystic and solid components and ascitic fluid. Resection of mass with abdominal hysterectomy with bilateral salphingo oophrectomy was done. No local or abdominal organ metastases were seen. Histopathology showed left broad ligament leiomyoma weighing 4000 grams with cystic degeneration. Conclusion: Huge broad ligament leiomyoma with cystic degeneration and abdominal ascites may cause diagnostic dilemma with ovarian malignancy. This differential diagnosis must be considered before surgery.
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Affiliation(s)
- Shabeen Naz Masood
- Dr. Shabeen Naz Masood, MBBS, MCPS, FICS, FCPS, PhD, DCPS, Consultant Obstetrician & Gynecologist, Medical Superintendent,Sobhraj Maternity Hospital, KMC, Karachi, Pakistan
| | - Yasir Masood
- Dr. Yasir Masood, MBBS, Ziauddin Medical University, Karachi, Pakistan
| | - Janta Mathrani
- Dr. Janta Mathrani, MBBS, MCPS trainee, Department of Obstetrics & Gynecology, Sobhraj Maternity Hospital, KMC, Karachi, Pakistan
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8
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Kato H, Kanematsu M, Ono H, Yano R, Furui T, Morishige KI, Hatano Y. Ovarian fibromas: MR imaging findings with emphasis on intratumoral cyst formation. Eur J Radiol 2013; 82:e417-21. [PMID: 23684385 DOI: 10.1016/j.ejrad.2013.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to assess MR imaging findings of ovarian fibromas with emphasis on intratumoral cyst formation. MATERIALS AND METHODS MR images with a 1.5-T unit obtained in 17 consecutive patients (age range, 18-87 years; mean age, 58 years) with 17 histologically proven ovarian fibromas were retrospectively reviewed for the size, configuration, signal intensity of solid components, and presence of cystic degeneration and edema within tumor. Size, number, and location of intratumoral cysts were also assessed. RESULTS The maximum diameter of tumors ranged from 3.3 to 19.1cm (mean, 10.9 cm). Seven (41%) tumors were multinodular. On T2-weighted images, solid components of tumors were heterogeneously mixed hypo- and hyperintensity in 16 (94%) tumors. Nine (53%) tumors demonstrated cysts and 16 (94%) demonstrated edema within tumor. The maximum diameter of the largest cysts ranged from 1.0 to 13.2 cm (mean, 6.4 cm), and the number of cysts per tumor ranged from 1 to 60 (mean, 15.6). Of the nine tumors with cystic formation, the predominant location of the cysts was peripheral in five (56%), exophytic in two (22%), central (11%) in one, and diffuse in one (11%). CONCLUSION Peripheral or exophytic cyst formation may be characteristic MR imaging features with ovarian fibromas.
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Affiliation(s)
- Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
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Galant Herrero J, Martí-Bonmatí L, Roca V, Calbo J, Picazo N, Puerta A. Visualización por resonancia magnética del drenaje venoso en las masas pélvicas: una ayuda para filiar su origen. RADIOLOGIA 2009; 51:171-5. [DOI: 10.1016/j.rx.2008.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 02/19/2008] [Indexed: 10/21/2022]
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11
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Keeling AN, Reidy JF. Imaging and treatment of uterine fibroids, including the role of uterine artery embolization. IMAGING 2007. [DOI: 10.1259/imaging/80403836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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12
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Imaoka I, Wada A, Kaji Y, Hayashi T, Hayashi M, Matsuo M, Sugimura K. Developing an MR imaging strategy for diagnosis of ovarian masses. Radiographics 2006; 26:1431-48. [PMID: 16973774 DOI: 10.1148/rg.265045206] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Magnetic resonance (MR) imaging provides useful information for characterization of various ovarian masses as neoplastic or nonneoplastic and, when neoplastic, on a spectrum from benign to malignant. The use of MR imaging for diagnosis of ovarian masses includes consideration of morphologic characteristics and signal intensity characteristics on T1- and T2-weighted images. The morphologic characteristics of cystic masses, cystic and solid masses, and predominantly solid masses provide important information. In general, cystic masses represent benign tumors, whereas cystic and solid masses are strongly associated with malignancy. Predominantly solid masses include benign, borderline malignant, and malignant tumors. T1-weighted images provide useful information for characterization because hemorrhagic adnexal masses (eg, endometriotic cyst) and cystic teratomas can be correctly diagnosed when the mass has high signal intensity. Significant low signal intensity in solid masses on T2-weighted images is indicative of fibrothecomas and Brenner tumors because extensive fibrous tissue produces significant low signal intensity on T2-weighted images. A strategy for diagnosis of ovarian masses with MR imaging incorporates signal intensity characteristics into morphologic characteristics.
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Affiliation(s)
- Izumi Imaoka
- Department of Radiology, Tenri Hospital, Tenri, Nara, Japan.
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Affiliation(s)
- Rachna Madan
- Department of Radio-diagnosis, Lady Hardinge Medical College, Associated Smt. S.K. Hospital & Kalawati Saran Children's Hospital, Z-16, Hauz Khas, New Delhi 110016, India.
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Kinkel K. Apport de l’IRM dans la prise en charge des fibromes utérins. IMAGERIE DE LA FEMME 2005. [DOI: 10.1016/s1776-9817(05)80652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Umeoka S, Koyama T, Togashi K, Kobayashi H, Akuta K. Vascular Dilatation in the Pelvis: Identification with CT and MR Imaging. Radiographics 2004; 24:193-208. [PMID: 14730046 DOI: 10.1148/rg.241035061] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Focal or diffuse dilatation of pelvic vessels is observed occasionally on computed tomographic or magnetic resonance images. Two major mechanisms may account for dilatation. The first mechanism is development of collateral channels as a result of venous obstruction or stenosis. Symptoms associated with vessel dilatation vary according to the level of obstruction. Portal hypertension also may result in the formation of numerous collateral vessels. In addition, left renal venous compression between the aorta and the superior mesenteric artery, which results in blood flow from the left renal vein toward the left gonadal vein, causes a variety of symptoms. The second major mechanism for dilatation is increased blood flow through collateral vessels associated with a neoplasm or vascular lesion. Hypervascular pelvic tumors such as uterine leiomyomas, gestational trophoblastic neoplasms, ovarian solid tumors, and mesenteric tumors may be associated with a marked increase in the number of draining vessels. The assessment of such vessels can assist in identification of tumor origins. Visual recognition of abnormal pelvic vasculature and abnormal hemodynamics is clinically important because it helps to improve diagnosis of a wide variety of pelvic and systemic diseases. Moreover, recognition of abnormal hemodynamics facilitates understanding of the physiology of such conditions. Recognition of the pattern of collateral channels also assists in identification of the level of narrowing even when the level is not readily apparent and is dependent on postural position.
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Affiliation(s)
- Shigeaki Umeoka
- Department of Nuclear Medicine and Diagnostic Imaging, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606-8507, Japan.
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Abstract
Sclerosing stromal tumors are rare benign ovarian neoplasms that are usually diagnosed in the second or third decade of life. Most patients with these tumors present with menstrual irregularities and pelvic pain. We present the magnetic resonance imaging (MRI) findings of a left ovarian sclerosing stromal tumor with torsion that was located in the right parauterine area, and discuss the differential diagnosis for this entity based on MRI findings. In this case, MRI demonstrated a well-defined, predominantly solid mass with a pseudolobular pattern, and showed a shift of the uterus to the left. The surgical and histopathologic aspects of the case are also described.
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Affiliation(s)
- H Yerli
- Department of Radiology, Baskent University School of Medicine, Ankara, Turkey.
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17
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Lee JH, Jeong YK, Park JK, Hwang JC. "Ovarian vascular pedicle" sign revealing organ of origin of a pelvic mass lesion on helical CT. AJR Am J Roentgenol 2003; 181:131-7. [PMID: 12818843 DOI: 10.2214/ajr.181.1.1810131] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We evaluated the "ovarian vascular pedicle" sign as a way of differentiating ovarian from subserosal uterine lesions on single-detector helical CT. SUBJECTS AND METHODS We prospectively evaluated 131 patients who had a pelvic mass suspected of originating in the ovary or subserosal zone of the uterus and had undergone helical CT before surgery. A total of 108 ovarian lesions and 23 subserosal uterine myomas were confirmed. CT images were analyzed prospectively by consensus of two radiologists who thoroughly evaluated the retrograde tracing of the gonadal veins to the ovary or pelvic mass. To assess the value of analyzing the ovarian vascular pedicle sign in identifying the organ of origin of a pelvic mass, we compared statistical proportions for the frequencies of the sign in ovarian tumors and subserosal uterine myomas by performing the chi-square test. The probabilities for the presence of the ovarian vascular pedicle sign as a positive finding for a pelvic mass of ovarian origin were calculated. RESULTS The presence of the ovarian vascular pedicle sign was identified in 92% (99/108) of ovarian masses and in 13% (3/23) of subserosal uterine myomas. The sign was statistically significant (p < 0.01) for differentiating a mass of ovarian origin from a mass of subserosal uterine origin. When the ovarian vascular pedicle sign on helical CT confirmed the ovarian origin, the sensitivity, specificity, positive predictive value and negative predictive value, and diagnostic accuracy were 92% (99/108), 87% (20/23), 97% (99/102), 69% (20/29), and 91% (119/131), respectively. CONCLUSION The presence of the ovarian vascular pedicle sign on helical CT is valuable for confirming the ovarian origin of a pelvic tumor and for differentiating an ovarian tumor from subserosal uterine myoma.
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Affiliation(s)
- Jong Hwa Lee
- Department of Diagnostic Radiology, Ulsan University Hospital, Ulsan University College of Medicine, 290-3 Choenha-Dong, Dong-Gu, Ulsan, 682-714, Korea
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Hughes JL, Reidy JF. Imaging and treatment of uterine fibroids including the role of uterine artery embolisation. IMAGING 2003. [DOI: 10.1259/img.15.2.150079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics 2002; 22:1305-25. [PMID: 12432104 DOI: 10.1148/rg.226025033] [Citation(s) in RCA: 256] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ovarian tumors are classified on the basis of tumor origin as epithelial tumors (serous and mucinous tumors, endometrioid and clear cell carcinomas, Brenner tumor), germ cell tumors (mature and immature teratomas, dysgerminoma, endodermal sinus tumor, embryonal carcinoma), sex cord-stromal tumors (fibrothecoma; granulosa cell, sclerosing stromal, and Sertoli-Leydig cell tumors), and metastatic tumors. Epithelial tumors are primarily cystic and, when malignant, are associated with varying proportions of a solid component. Papillary projections are a distinctive feature of epithelial tumors. Profuse papillary projections are highly suggestive of borderline (low-malignant-potential) or malignant tumor. Ovarian teratomas demonstrate lipid material at computed tomography and magnetic resonance (MR) imaging. Malignant germ cell tumors manifest as a large, complex abdominal mass that contains both solid and cystic components. Tumor markers are helpful in diagnosis. The radiologic appearance of sex cord-stromal tumors varies from small solid masses to large multicystic masses. Granulosa cell tumors are usually large multicystic masses with solid components. Fibrothecoma, sclerosing stromal tumor, and Sertoli-Leydig cell tumors are usually solid masses. Fibromas have very low signal intensity on T2-weighted MR images. Certain radiologic findings predominate for each type of tumor. Knowledge of these key features of ovarian tumors provides the criteria for making a specific diagnosis or substantially narrowing the differential diagnosis.
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Affiliation(s)
- Seung Eun Jung
- Department of Radiology, St Mary's Hospital, Catholic University of Korea, 62 Yeouido-dong, Youngdungpo-gu, Seoul 150-713, Korea.
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Smith AK, Coakley FV, Jackson R, Gordon RL. CT and MRI of retroperitoneal edema associated with large uterine leiomyomas. J Comput Assist Tomogr 2002; 26:459-61. [PMID: 12016381 DOI: 10.1097/00004728-200205000-00026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Two cases of retroperitoneal edema surrounding the left ovarian vein that were associated with large uterine leiomyoma are presented. This finding was not associated with any specific lateralizing symptoms or with any evidence of malignancy. One patient underwent hysterectomy with surgical exploration of the retroperitoneum that confirmed the absence of malignancy. The CT and MR findings in this entity are described and possible etiological mechanisms discussed. Recognition that large leiomyoma can be associated with benign retroperitoneal edema may help avoid inappropriate management.
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Affiliation(s)
- Alexander K Smith
- Department of Radiology, University of California at San Francisco, 94143-0628, USA
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21
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Kim SH, Sim JS, Seong CK. Interface vessels on color/power Doppler US and MRI: a clue to differentiate subserosal uterine myomas from extrauterine tumors. J Comput Assist Tomogr 2001; 25:36-42. [PMID: 11176291 DOI: 10.1097/00004728-200101000-00007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE In subserosal myomas, vessels are often demonstrated between the masses and the uterus. This study was performed to assess the usefulness of demonstrating these vessels in differentiating subserosal myomas from extrauterine tumors on color or power Doppler US (CDUS/PDUS) and MRI. METHOD This retrospective study included 41 patients with subserosal myomas and 27 patients with solid extrauterine tumors. The incidence and shape of these vessels seen on CDUS/PDUS and MRI were compared in the myoma and extrauterine tumor groups. RESULTS The interface vessels were demonstrated in 39 of 41 subserosal myomas (18 on CDUS/PDUS, 14 on MRI, 7 on both), whereas they were seen in only 3 of 27 extrauterine tumors (1 on CDUS/PDUS, 2 on MRI). These three extrauterine tumors were ovarian malignancies that directly invaded the uterus. The shapes of these interface vessels were 7 intervening, 12 crossing, and 20 mixed in the myoma group, whereas they were mixed in all three extrauterine tumor groups. The sensitivity/specificity of this finding in differentiating subserosal myomas and extrauterine tumors was 100/92%, 91/91%, and 95/89%, respectively, with CDUS/PDUS, MRI, and either CDUS/PDUS or MRI. CONCLUSION Observation of the interface vessels between the uterus and juxtauterine masses seems to be a useful clue in differentiating subserosal myomas from extrauterine tumors.
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Affiliation(s)
- S H Kim
- Department of Radiology, Seoul National University College of Medicine and Institute of Radiation Medicine, Korea.
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22
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Tanaka YO, Nishida M, Yamaguchi M, Kohno K, Saida Y, Itai Y. MRI of gynaecological solid masses. Clin Radiol 2000; 55:899-911. [PMID: 11124069 DOI: 10.1053/crad.2000.0600] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Differential diagnosis of gynaecological masses is sometimes difficult, as there are so many histological types. However, magnetic resonance characteristics of some gynaecological tumours have been reported past several years. On the basis of the recent literature, we have made a decision tree for differential diagnosis of solid gynaecological tumours, in which there are some important divergences. Bilateral disease and invasive growth are malignant signs in most cases. Specific findings for different tumour types include: fibrovascular septa in dysgerminomas; preserving ovarian follicles in round cell tumours; pseudolobular patterns in young patients in sclerosing stromal tumours; and extremely hypointense masses on T2WI in Brenner tumours. Distinguishing between sex-cord stromal tumours, Brenner tumours and metastatic tumours may be hard, however, especially in middle age, because they all tend to show well-demarcated, hypointense masses on T2WI. Disproportionately clear zonal anatomy of the uterus, enlarged uterus and thickened endometrium, which are indirect findings of oestrogen-producing tumours, are useful diagnostic findings in children and postmenopausals.
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Affiliation(s)
- Y O Tanaka
- Department of Radiology, University of Tsukuba, Tsukuba-Gakuen Hospital, Japan.
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Umesaki N, Tanaka T, Miyama M, Ogita S, Ochi H. Combined diagnostic imaging of uterine carcinosarcoma: A case report. Int J Gynecol Cancer 2000; 10:425-428. [PMID: 11240709 DOI: 10.1046/j.1525-1438.2000.010005425.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The diagnostic imaging characteristics of uterine carcinosarcoma have not been established because the tumor is very rare. We studied magnetic resonance (MR) imaging, power Doppler ultrasonography, and positron emission tomography (PET) in one such carcinosarcoma to define its imaging characteristics. On T1-weighted MR images, the tumor mass in the uterus was low-signal intensity and had a slight inhomogeneous appearance. On T2-weighted images, it had a heterogeneous appearance and was of medium- or high-signal intensity; marked flow void was apparent from the myometrium to the tumor mass. The MR flow void was also detected by power Doppler ultrasonography. Increased glucose metabolism was detected on PET images, suggesting a malignant tumor in the endometrial cavity. Combined diagnostic images with MR, power Doppler ultrasonography, and PET is recommended as the diagnostic method for uterine carcinosarcoma.
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Affiliation(s)
- N. Umesaki
- Department of Obstetrics and Gynecology and Division of Nuclear Medicine, Osaka City University Medical School, 1-4-3, Asahi-machi, Abeno-ku, Osaka, Japan
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Ueda H, Togashi K, Konishi I, Kataoka ML, Koyama T, Fujiwara T, Kobayashi H, Fujii S, Konishi J. Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds. Radiographics 1999; 19 Spec No:S131-45. [PMID: 10517450 DOI: 10.1148/radiographics.19.suppl_1.g99oc04s131] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Typical appearances of uterine leiomyoma at magnetic resonance (MR) imaging are well established, and diagnosis is usually easy. However, cases that, are extremely difficult to differentiate from other conditions are occasionally encountered. 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. The common types of degeneration are hyaline (>60% of cases), cystic (approximately 4%), myxoid, and red. Edema is not a phenomenon of degeneration but is a common histopathologic finding (approximately 50% of cases). Hemorrhage, necrosis, and calcification (approximately 4% of cases) may also be observed. 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. 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. 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.
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Affiliation(s)
- H Ueda
- Department of Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan
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Abstract
This article reviews the most recent studies incorporating diagnostic imaging modalities into gynecologic and obstetric care. It describes studies evaluating the utility of various imaging modalities for the diagnosis of fetal abnormalities, uterine and tubal pathology, and staging of gynecologic malignancies. In addition, the article reviews some experimental studies and their potential clinical applications.
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Affiliation(s)
- H Winer-Muram
- Clinical Radiology, Cornell University, New York, USA
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