cystic degeneration of fibroid ct
6B —45-year-old woman who underwent MRI to evaluate size of uterine fibroids. If a leiomyoma undergoes myxoid degeneration, then hypocellularity and a myxoid matrix without nuclear atypia or other features of malignancy is seen. MRI provides more accurate morphological soft-tissue detail when compared with computed tomography (CT), and has a useful pre-operative role in some cases, particularly in monitoring fibroid degeneration and identifying sarcomatous changes. This term is related but not. Fig. 4A —45-year-old woman with symptomatic fibroids who underwent MRI for preoperative planning. Cystic degeneration is evidenced by internal areas of T2 hyperintensity (fluid signal) with a lack of contrast enhancement . On ultrasound, the detection of hypervascularity in a large solitary uterine mass can identify suspicious masses, such as a leiomyosarcoma . Specifically, a rapidly growing uterine mass is not a reliable predictor of leiomyosarcoma according to Parker et al. Fig. Fig. In one of the largest series on uterine STUMPs, Guntupalli et al. One patient with STUMP was found to have implants on the rectosigmoid colon when undergoing surgical reexploration 102 days after a power morcellation procedure. Once the degeneration is complete, any pain or fever usually goes away. Although CT is not a recommended imaging modality for the evaluation of leiomyomas, they are frequently incidentally seen, usually appearing as a variably enhancing mass, sometimes with dystrophic calcifications . , who conducted a review of 1332 patients who underwent surgery for presumed leiomyoma and concluded that, “The incidence of sarcoma among patients having surgery for ‘rapidly growing' leiomyoma (0.27%) or among those who met published criteria for rapid growth (0%) does not substantiate the concept of increased risk of sarcoma in these women.” Thus, the diagnosis of a variant cannot be made with certainty until a pathologist thoroughly evaluates the surgically removed fibroid (see the Pathologic Features of Leiomyoma Variants section later in this article). Although there are some suggestive features, the diagnosis of a leiomyoma variant is usually made postoperatively at pathologic examination. One case report  of an atypical leiomyoma arising from the vaginal fornix was well defined, moderately T2 intense, and homogeneously enhanced. Although benign, they can be associated with significant morbidity and are the commonest indication for hysterectomy. Uterine leiomyomas, commonly known as fibroids, are one of the most common pelvic tumors found in women. An intermediate T2 signal and a high b value (1000 s/m2) signal were found in STUMPs and malignant tumors significantly more often than in benign tumors. Generally, the ultrasonic appearance of uterine fibroids is typical, and diagnosis is uncomplicated. The World Health Organization has recently (2014) updated its criteria for mesenchymal tumors of the female reproductive tract , and variants of benign smooth muscle tumors are diagnosed according to their unusual histologic features. Cellular leiomyomas are more likely to be singular and larger than ordinary leiomyomas; there is also a higher likelihood that endometriosis or adenomyosis is absent, that the patient is symptomatic with menometrorrhagia, and that the indication for the imaging study is “enlarging leiomyoma” . Maria Luisa C. Fogata MD. 3, Journal of Minimally Invasive Gynecology, Vol. 3, Journal of Computer Assisted Tomography, Vol. 2C —53-year-old woman with indeterminate mass on ultrasound. Internal echo-poor foci suggest degeneration , and a hyperechoic echo pattern may suggest a lipoleiomyoma . is a prerequisite for the development of targeted therapies against these lesions” (uterine leiomyomas). As fibroids enlarge, they may outgrow blood supply and they may degenerate. describe the CT findings of uterine leio- myomas and their secondary changes, including cystic degeneration, calcification, infection, necrosis, fatty degeneration . Hemorrhagic (carneous) degeneration typically shows high signal intensity on T1-weighted scans and moderate to high signal intensity on T2-weighted scans; there can also be a hyperintense rim on T1-weighted scans and a very hypointense rim on T2-weighted scans [ 31 ]. 24: A. Ultrasound is the first-line imaging modality because it is a cost-effective portable real-time examination that provides good anatomic detail without radiation. Except for two, all were solid cystic masses whose solid part showed hypo- or isointensity on T1-weighted sequences, hyperintense signal intensity on T2-weighted scans, and heterogeneous enhancement. 22, No. Cystic Fibroids Degeneration Cystic degeneration is not so common type of fibroids degeneration; it affects only 4% of all fibroids and usually occurs after menopause. Ultrasound and CT -Scan suggested “Ovarian Malignancy”!! For example, in one of the largest series on this variant, Ly et al. Once the degeneration is complete, any pain or fever usually goes away. Uterine fibroids can undergo hyaline, cystic, myxoid, and red degeneration. The ultrasonographic and contrast-enhanced computed tomographic findings of this case were characteristic of ovarian neoplasm. 4, 1 November 2009 | RadioGraphics, Vol. 14, No. However, the sonographic characteristics of fibroids undergoing cystic degeneration, and especially those of the submucous type, may be misleading. C, Axial T1-weighted fat-suppressed IV contrast-enhanced scan shows heterogeneous enhancement. B A C vol25_no5_jum_online.q 4/14/06 10:26 AM Page 673. characteristic of a rim of myometrium usually seen in a cystic fibroid.5 The cesarean delivery surgical report stated that the 18-cm pedunculat-ed cystic mass arose from the posterior surface of the body of the uterus and extended inferiorly in the cul-de-sac. Moreover, most of these STUMPS with a malignant potential are p53 and p16 positive. CONCLUSION. Hemorrhagic (carneous) degeneration typically shows high signal intensity on T1-weighted scans and moderate to high signal intensity on T2-weighted scans; there can also be a hyperintense rim on T1-weighted scans and a very hypointense rim on T2-weighted scans . Fig. Linear signal void along posterior fundus represents prior myomectomy changes after removal of conventional fibroid. Nonetheless, the bottom line is that, at the present time, the diagnosis of a leiomyoma variant cannot be made with certainty until a pathologist, guided by recently updated 2014 World Health Organization criteria , thoroughly examines the specimen. Although cystic degeneration of uterine fibroids is relatively uncommon, the presence of flow signal on color or power Doppler ultrasound or curvilinear continuous flow voids on MRI in a pedicle bridging the mass and the myometrium suggests a uterine origin of these exophytic lesions, as in this case. 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