However, frequently these tumors are not accompanied by symptoms, and they are found incidentally during computed tomographic (CT) examinations performed for other indications. However, the cystic areas do not enhance well and can be distinguished from other types of leiomyomas. For example, although Kim et al. smooth muscle tumors of uncertain malignant potential, MR Imaging Differentiation of Soft-Tissue Hemangiomas from Malignant Soft-Tissue Masses, Review. 1. Epidemiology This type of degeneration is thought to represent ~4% of all types of degeneration. Fig. After surgery, mass was found to be atypical leiomyoma. non-degenerated fibroids and calcification appear as low to intermediate. Heterogeneous enhancement, although subjective to some degree, was more frequent in the malignant than in the benign group, and perfusion imaging was not useful for either group; because the uncertain malignant potential tumors were grouped with the malignant tumors, the imaging differences between these groups remain unclear. Being rare in prepubertal females, they commonly accelerate in growth during pregnancy and involute with menopause 1. Fig. Int J Gynecol Endsc 2017;1(1):46-49. Computed tomography. Precise knowledge of the histopathologic backgrounds of degeneration and the clinical course helps u… [9] reviewed 127 patients representing the pathologic spectrum, from uterine leiomyomas to leiomyosarcomas, using World Health Organization and Stanford criteria. If a leiomyoma undergoes fatty degeneration, pathologically the lipoleiomyoma has an integral component of mature adipose tissue. Typical appearance of fibroid uterus on CT. Patient risk factors—such as increasing age, race (African American), long-term (≥ 5 years) Tamoxifen use, pelvic radiation, and certain high-risk conditions (i.e., hereditary leiomyomatosis and renal cell carcinoma syndrome and hereditary childhood retinoblastoma)—can and should be taken into account, with the caveat that they too are insufficiently studied because of the overall low incidence of uterine sarcomas. Fig. Your doctor may feel moderate and large uterine fibroids during a routine. Atypical leiomyomas and STUMPs routinely express progestin receptors [20]; however, because of the low recurrence rates, there is no role established for adjuvant hormonal therapy. Because leiomyomas may first be noted on CT scans, radiologists should become familiar with their characteristic appearance. 24, No. Extremely prevalent, they occur in more than 20% of women older than 30 years (,1,,2). 4, Korean Journal of Radiology, Vol. 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” [11]. After surgery, mass was found to be atypical leiomyoma. If the tumor is troubling you, or if it is growing rapidly, or the radiologist has other concerns, you should consider having it removed or you may be given other options such as embolization. Cystic degeneration is evidenced by internal areas of T2 hyperintensity (fluid signal) with a lack of contrast enhancement [30]. Fig. However, despite the rarity of the latter, both the clinician and radiologist caring for a woman with presumed benign myomas sometimes share the underlying worry that they could be dealing with a leiomyosarcoma. A case of massive cystic degeneration in a uterine fibroid 21 cm × 16 cm × 12 cm. In contrast to coagulative tumor cell necrosis seen in malignant leiomyosarcomas, infarction necrosis observed in ordinary benign leiomyomas is typically zonal, with necrotic smooth muscle cells surrounded by rims of granulation to hyalinized fibrous tissue. Another article [39] reported that uterine sarcomas (five leiomyosarcomas and two endometrial stromal sarcomas) and two cellular leiomyomas exhibited high signal intensity on DWI sequences, whereas ordinary leiomyomas (including degenerated ones) showed low signal intensity; however, as acknowledged, a statistical analysis was not performed because of the small sample size. MRI was interpreted as worrisome for leiomyosarcoma; therefore, she instead underwent hysterectomy, performed by gynecologic oncologist, which confirmed MRI diagnosis. 5C —39-year-old woman with pelvic pain and presumed ordinary leiomyoma after receiving therapy with leuprolide acetate (Lupron, Abbvie). Fig. Fig. Key teaching point, in this case, is that cystic degeneration of fibroids can look very large and alarming and raise the concern for a malignant mass. Discover the world's research 9,22,23. A history of tamoxifen use for more than five yea… 205, No. Taran et al. Ultrasonography is the primary modality for evaluating leiomyomas. One case report [38] of an atypical leiomyoma arising from the vaginal fornix was well defined, moderately T2 intense, and homogeneously enhanced. 3, Journal of the Korean Society of Radiology, Vol. If disease is present, then more-intense imaging surveillance could be considered, but guidelines have not yet been established. Fig. A surgical approach is safe … Leiomyomas are by far the most common uterine tumors and the most common gynecologic tumors. On ultrasound, the detection of hypervascularity in a large solitary uterine mass can identify suspicious masses, such as a leiomyosarcoma [27]. Though fibroid degeneration does decrease the size of fibroids, it cannot manage them long-term — a degenerated fibroid is likely to expand and degenerate again. B, Oblique axial T2-weighted scan shows that mass arises from uterus and has peripheral high signal intensity with laminated low signal intensity. These atypical smooth muscle cells have abundant eosinophilic cytoplasm, irregular nuclear shapes, and multinucleation. Fibroids are noncancerous tumors that grow on or in the muscular walls of the uterus. 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