MRI appearance of primary giant ovarian leiomyoma in a hysterectomised woman

Primary Ovarian Leiomyoma Associated with Multiple Uterine Leiomyomas

Ovarian leiomyomas are very rare. We report the case of a primary ovarian leiomyoma accompanied by multiple uterine leiomyomas. A 50-year-old woman was referred to our department for heavy menstruation, and a hot spot in the uterine lumen was observed on positron emission tomography-computed tomography (PET-CT). Cervical and endometrial cytology and tumor marker tests were negative. Pelvic magnetic resonance imaging revealed an endometrial polyp and submucosal leiomyoma in the uterine lumen and a 5-cm right ovarian tumor. Laparoscopic total hysterectomy, right salpingo-oophorectomy, and left salpingectomy were performed for radical treatment. Histopathology showed that ovarian tumors contained interlacing bundles of fusiform cells encircled by normal ovarian tissue. Immunohistochemical staining showed strong and diffuse positive staining for α-smooth muscle actin. We diagnosed the tumor as a primary ovarian leiomyoma because the leiomyoma was localized in the ovary and was larger than the size of uterine leiomyomas. No metastatic lesion was found on PET-CT. There was no tumor recurrence at the 6-month follow-up.

Primary ovarian leiomyoma with predominant cystic change

Ovarian leiomyoma is a rare benign tumor, seen mostly in women 20-65 years old. The case of a 51-year-old woman with a large tumor in the pelvic cavity is reported. The dominant feature of the tumor was its cystic component, but an irregular, solid component was recognized along the dorsal margin of the tumor. The latter area showed signal intensity as low as muscle on T2-weighted images and significant contrast enhancement; however, it did not show restricted diffusion, which implied that it was benign. The large tumor was resected because malignancy could not be ruled out, and it was pathologically diagnosed as ovarian leiomyoma with predominant necrosis. When a low-intensity component without malignant features is seen on magnetic resonance imaging, leiomyoma should be included in the differential diagnosis despite its rare occurrence in the ovary.

Unusual MR findings in ovarian leiomyoma

We report a rare case of ovarian leiomyoma with extensive edema in a 55-year-old woman. Magnetic resonance (MR) imaging revealed an ovarian mass with distinct portions of predominantly low intensity and predominantly high intensity on T2-weighted image. The portion with low signal showed weak enhancement on contrast study, and the portion with high intensity suggested extensive edema of fibrous stroma. Furthermore, the mass showed low signal intensity similar to that of the myometrium on diffusion-weighted image and yielded high values on apparent diffusion coefficient (ADC) map image. Extensive edema of ovarian leiomyoma shows unusual MR imaging findings that require careful interpretation.

Radiologic Evaluation of Mesenchymal Tumors of the Female Genital Tract

Mesenchymal neoplasms of the female genital tract are a diverse group of tumors, of which the most common are smooth muscle tumors. There is a significant overlap in the imaging characteristics of benign and malignant tumors and final diagnosis often requires pathologic correlation. However, familiarity with typical radiologic features, common imaging pitfalls, and the utility of different imaging modalities can be valuable in the evaluation of mesenchymal tumors. This article highlights the imaging features of the most commonly encountered mesenchymal tumors in the female genital tract.

The relation between the presence of a giant primary ovarian leiomyoma and the occurrence of epilepsy as a paraneoplastic syndrome

INTRODUCTION

Primary ovarian leiomyoma is a quite rare tumor and usually it is small and unilateral. Most cases are asymptomatic. This benign tumor is usually diagnosed incidentally on routine pelvic examination or in pathologic specimens at surgery or at autopsy.

CASE PRESENTATION

In this case, a patient with her first epileptic seizure was admitted to our emergency department. Following the initial treatment in neurology clinics, patient claimed of an abdominal pain, so by abdominal ultrasonography, it was determined that the patient had a giant abdominal mass measured 30 x 28 x 15 cm in diameter which was clinically diagnosed as malign ovarian tumor.

CONCLUSION

At laparotomy, a radical hysterectomy was performed. It was reported as ovarian leiomyoma on pathological evaluation. After 15 days of surgery, patient is discharged without any complications and also no more epileptic seizures.

Incidence, clinical analysis, and management of ovarian fibromas and fibrothecomas

OBJECTIVE

The objective of the study was to identify the incidence, diagnosis, and therapeutic and histological particularities of ovarian fibromas and fibrothecomas.

STUDY DESIGN

This was a retrospective study of 24 patients who underwent surgical treatment for ovarian fibromas and fibrothecomas between January 1994 and December 2006. Clinical, ultrasonographic, tumor marker, therapeutic, and histologic data were analyzed.

RESULTS

The mean age of patients was 49 years. Thirteen patients were menopausal. Ultrasonographic findings were ovarian echogenic tumor in 6 cases, hypoechogenic tumor in 12 cases, mixed tumor in 6 cases, and anechogenic tumor in 1 case. Cancer antigen-125 level measured in 21 cases was abnormal in 3 cases. Twenty-one patients underwent laparotomy. Three patients underwent laparoscopy; however, 1 was converted to laparotomy because of a suspected tumor. Histological findings were 16 fibromas and 9 fibrothecomas.

CONCLUSION

Ovarian fibromas and fibrothecomas are uncommon, accounting for 3.3% of ovarian tumors. These lesions often occur in perimenopausal and menopausal patients. Clinical, ultrasonographic, and tumor marker data remain the best preoperative approach currently available for ovarian tumors. However, the diagnosis remains histological.

Aspects of an ovarian osteoma on magnetic resonance imaging and computerized tomography

OBJECTIVE

To describe the contribution of magnetic resonance imaging (MRI) and computerized tomography (CT) scan to the diagnosis of an ovarian osteoma.

DESIGN

Descriptive case study.

SETTING

Tertiary care center, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, University Pierre et Marie Curie, Paris, France.

PATIENT(S)

A 29-year-old woman with a left-sided calcified ovarian tumor on MRI and CT scan, suggesting an ovarian osteoma.

INTERVENTION(S)

Surgical removal of a 64-mm primary ovarian osteoma, exclusively by the vaginal route.

MAIN OUTCOME MEASURE(S)

The MRI and CT scan findings.

RESULT(S)

Histologic examination showed an ovarian osteoma characterized by mature bone tissue, with no signs of malignancy.

CONCLUSION(S)

Ovarian osteoma can be adequately diagnosed by MRI or CT scan and can be treated conservatively.