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BENIGN
BENIGN
Normal Anatomy
MM
Junctional
JZ
Zone
EE
Normal Uterus/Cervix
Uterine Leiomyoma
Most common uterine neoplasm
Occur in women of reproductive age and are
under hormonal influence
Enlarge during pregnancy or BCP use
Regress after menopause
Symptoms
Dysmenorrhea
Menorrhagia
Infertility
Pressure sensation
Uterine Leiomyoma
As they grow, they may outgrow their blood
supply, resulting in various types of
degeneration
Hyaline (homogeneous eosinophilic proteinaceous material)
Myxoid (hyaluronic acid-rich mucopolysccharide gelitenous
material)
Cystic
Hemorrhagic (red or carneous, occurs in pregnancy or with
BCPs)
Calcific
Uterine Leiomyosarcoma
Sarcomatous transformation of preexisting
leiomyoma is rare
Diagnosis usually made as an incidental
pathologic diagnosis in 0.5% or resected
fibroids
Uterine Leiomyoma
Edema is common
Scattered or diffuse
Frequently prominent at periphery
With extensive edema, get marked
enhancement due to retention of contrast
material within the abundant interstitial spaces
Okizuka H, et al. J comput Assist Tomogr 1993;17:760-766
Suspect Leiomyosarcoma
Uterine Leiomyoma
Differential Diagnosis
Uterine sarcoma
Leiomyosarcoma
Mixed mullerian tumor
Endometrial stromal sarcome
Adenomyosis
Solid ovarian masses (fibroma, fibrothecoma, Brenner tumor)
Myometrial contractions
Endometrial cancer
Endometrial polyp
Gestational Trophoblastic Disease
Retained products of conception
Ovarian Fibromas/Fibrothecomas
Fibroid
Adenomyosis
Hormonally resistant endometrial glands (basalis type)
and stroma deep within the myometrium
Smooth muscle hyperplasia and hypertrophy
induced
around glands
Histologically present in >40% women
MR Findings in Adenomyosis
Broadening of junctional zone
Poorly defined low signal contiguous with junctional
zone
Low signal myometrial mass (adenomyoma)
Punctate high signal on T2WIs (glandular cystic
changes)
high resolution images helpful
Adenomyosis
> 12 mm = adenomyosis
8 - 11 mm = c/w adenomyosis if clinical findings
< 7 mm = nornal
Pitfalls
Junctional zone may widen (focally or
diffusely) on days 1-2 of menstrual cycle
Junctional zone may widen with
dysmenorrhea
Uterine contractions
Focal
Striated
Summary
Leiomyoma
Round
Mass effect
Adenomyoma
Oval with long axis
paralleling uterus
Relatively little mass
effect
Indistinct margins
Punctate
hyperintense foci