J Korean Soc Radiol.  2017 Jul;77(1):61-66. 10.3348/jksr.2017.77.1.61.

Degenerated Uterine Leiomyomas Mimicking Malignant Bilateral Ovarian Surface Epithelial Tumors

• Hwang J
• Yi BH
• Lee HK
• Lee MH
• Choi SY
• Chung SH

• KMID: 2384738
• DOI: http://doi.org/10.3348/jksr.2017.77.1.61

Abstract

Uterine leiomyomas are the most common benign uterine neoplasms. Undegenerated uterine leiomyomas are easily recognizable by the typical imaging findings on radiologic studies. However, degenerated fibroids can have unusual and variable appearances. The atypical appearances due to degenerative changes may cause confusion in diagnosis of leiomyomas. In this article, we report a case of a patient with extensive cystic and myxoid degeneration of uterine leiomyoma, mimicking malignant bilateral ovarian surface epithelial tumors.

MeSH Terms

Diagnosis
Humans
Leiomyoma*
Magnetic Resonance Imaging
Tomography, X-Ray Computed
Ultrasonography
Uterine Neoplasms
Uterus

Figure

• 

  Fig. 1 Radiologic and surgical images of uterine myoma with extensive cystic and myxoid degeneration in a 45-year-old female. A. Transabdominal ultrasound shows a huge mixed cystic and solid mass in the pelvic cavity with extension to the epigastric area. Multiple irregularly thick septae with lobulated echogenic nodular areas (arrow) are noted within the mass. B. On coronal reformatted contrast enhanced CT image, there are two large lobulated cystic masses with enhancing solid areas and focal enhancing thick septae. The left ovary is visualized, but on CT, the right ovary is not definite. C. On T1-weighted axial image, the cystic mass in the right abdomen shows intermediate signal intensity, but the left-side cystic mass shows high signal intensity, indicating different fluid contents. D, E. T2-weighted axial (D) and coronal (E) images reveal multiple small locules with variable signal intensities and fluid-fluid levels (arrowheads) with low signal intensity solid portions in the masses (arrows). F. Gd-enhanced fat-saturated T1 image shows homogeneous enhancement of solid portions within the cystic mass (arrow). The uterus (arrowheads) is seen adjacent to the cystic mass. G. At the bottom of the cystic and solid masses, both ovaries are noted on each side of the uterus (arrowheads). The left ovary is separated from the masses (white arrow) but the right ovary abuts on the mass, but its contour is relatively well preserved (yellow arrow). H. PET-CT image shows increased FDG uptake in the enhancing solid portion of the masses (arrow), suggestive of a malignant tumor. I. During the operation, two large cystic masses are found to originate from the uterus. The right ovary and the fallopian tube are attached to the tumor (arrowheads). J. Cut surface of the specimen shows extensive hemorrhagic necrosis (white arrows) with cystic change (yellow arrow). A whitish-gray solid myoma portion (arrowheads) is seen. FDG = fluorodeoxyglucose, PET = positron emission tomography

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