A degenerating cystic uterine fibroid mimicking an endometrioma on sonography

Beware of a multi-fibroid uterus: The importance of ultrasound reporting in the early detection of uterine sarcomas

Primary uterine malignancy masquerading as a benign leiomyoma is a rare yet devastating condition if missed on ultrasound. Although there are no current guidelines to aide in early ultrasound identification of these high-risk patients prior to histological analysis, certain imaging characteristics may heighten the suspicion of malignancy. Unfortunately, these atypical features are often not included in ultrasonographic reports resulting in delayed treatment and catastrophic consequences. We present a case of a uterine Ewing's sarcoma (ES), which was diagnosed as a multi-fibroid uterus on initial ultrasound. The lack of clinical suspicion resulted in a delay to definitive diagnosis and a sub-optimal surgical resection. We compare this to a standard case of a multi-fibroid uterus in order to highlight the differences in ultrasonographic appearance. This case delineates the importance of accurate identification and open reporting of suspicious features in order to assist ultrasonographers and specialist gynaecologists in creating a differential diagnosis of an otherwise common condition. A high index of suspicion of atypical lesions may lead to early life-saving interventions and careful tissue control during surgery, resulting in improved patient outcomes.

Placenta accreta associated with submucosal fibroid polyp

A 35-year-old para 1, whose child birth was 5 years ago, was on barrier contraception and safe period. She was diagnosed to have a small submucosal posterior wall fibroid when she planned for her second child now. She conceived spontaneously during the next cycle after consultation. Her first trimester ultrasonography revealed placental implantation on the fibroid. She developed severe pre-eclampsia at 32 weeks of pregnancy and suffered from uncontrolled hypertension. and pulmonary oedema. Pregnancy was terminated at 33+4 weeks by elective lower segment caesarean section (LSCS) because of severe pre-eclampsia, pulmonary oedema and unfavourable cervix. At LSCS, placenta was found to be adherent to the pedunculated fibroid polyp which was removed by clamping, cutting and ligating the pedicle. Histopathological examination revealed placenta accreta and hyaline change of leiomyomatous polyp. Fetus was preterm, weighed 2.1 kg and survived.

Degeneração cística maciça de leiomioma uterino em gestante simulando neoplasia ovariana: relato de caso

Os autores descrevem o caso de uma gestante encaminhada por apresentar massa anexial. A ultra-sonografia demonstrou volumosa lesão sólido-cística sugestiva de neoplasia ovariana. A ressonância magnética mostrou que a lesão era recoberta pela serosa uterina, sugerindo mioma degenerado. O correto diagnóstico das massas pélvicas na gestação é fundamental para o estabelecimento da terapêutica. A ressonância magnética traz importantes contribuições no diagnóstico dessas entidades.