A myomectomy on pregnant uterus and total abdominal hysterectomy and bilateral salpingoophorectomy was respectively performed successfully. Here we describe a case of marked cystic degeneration of an exophytic uterine fibroid, which sonographically simulated an endometrioma. 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 ]. Ultrasonography (USG) and CT showed a large mass abutting the uterus extending into the abdomen. In conclusion, as cystic degeneration of fibroids is a rare entity, observed only in 4% of leiomyomas, this frequently results in unusual clinical presentation and diagnostic dilemmas. This antiangiogenic mechanism is likely to be responsible for the cystic myoma degeneration in our case 4. Cystic degeneration may be considered an extreme sequela of edema and is observed in about 4% of leiomyomas (, 1). This report exemplifies how challenging the diagnosis could be with fibroid degeneration. A pelvic mass was felt, and computed tomography demonstrated a 13-cm hypodense multilocular cystic mass … Leiomyomas are by far the most common uterine tumors and the most common gynecologic tumors. A history of tamoxifen use for more than five yea… The signal characteristics of the cystic mass did not satisfy the signal intensities of an endometrioma. Degeneration, involving cell death, occurs inside the fibroid, and calcification, where calcium is deposited in the fibroid tissue, may be seen on an ultrasound scan. Magnetic resonance imaging was thus justified to clarify the diagnosis. A case of massive cystic degeneration in a uterine fibroid 21 cm × 16 cm × 12 cm mimicking malignant ovarian tumor. Ultrasound of the pelvis and CT scan of the abdomen and pelvis showed a 12 cm mass arising from the posterior wall of the uterus with irregular margin inferiorly, raising suspicion of a ruptured mass. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. In rare circumstances, the fibroid grows … 2, A and B). Notice how the endometrial stripe is displaced along the posterior/leftward aspect of the mass, indicating that this is a large anterior and exophytic fibroid … Acute pain occurs in 30 % of women with uterine fibroids, usually due to acute degeneration or torsion of pedunculated subserosal myomas or prolapse of pedunculated submucosal ones. TA USG image (A) shows a 7-cm intramural fibroid containing cystic areas (arrows). Working off-campus? Ltd. All rights reserved. The differential diagnosis included rare possibility of giant fibroid with cystic degeneration. They are living tissue, requiring oxygen and nutrients to survivie and grow, supplied by blood vessels in an around the uterus. The diagnosis of a uterine fibroid with cystic degeneration was made. This report describes a unique sonographic appearance of a cystic uterine fibroid, which simulates the sonographic appearance of an endometrioma. cystic fluid measured about 8.2litres. Department of Radiology, University of California, Davis Medical Center, Sacramento, California USA. i have a 10 cm fibroid degeneration (necrobiosis). The mass was found to be arising from posterior fundal area more on the right involving the entire posterior surface and filling the abdomen. Magnetic resonance imaging (MRI) of the pelvis was recommended to further characterize this cystic lesion. Histopathological examination confirmed a pedunculated broad ligament leiomyoma with cystic degeneration. Leiomyomas can undergo degeneration, which can result in a variety of sonographic appearances. Their typical appearances at magnetic resonance (MR) imaging have been well established (,3,,4). Axial T2W MRI image (B) shows an 11 × 8 cm fibroid (arrows) containing central high signal, consistent with cystic degeneration (arrowhead) Images in this article. Fibroids are living tissue, and need blood and oxygen to survive. Postmenopausal Uterine Leiomyoma with Hemorrhagic Cystic Degeneration Mimicking Ovarian Malignancy. She had uneventful post-operative recovery and was discharged on day 5. A case of massive cystic degeneration in a uterine fibroid 21 cm × 16 cm × 12 cm mimicking malignant ovarian tumor. Broad ligament is the common extrauterine site for fibroid. Cystic degeneration is an uncommon type of degeneration that a uterine leiomyoma can undergo. Ultrasound imaging revealed a large multilocular cystic pelvic mass sized 10x11 cm suspicious of a malignant tumor and abdominal hysterectomy was performed. This report exemplifies how challenging the diagnosis could be with fibroid degeneration. See also endometrial cancer, benign tumors of the endometrium, and differential diagnosis of dysmenorrhea and menorrhagia Copyright © 2021 Elsevier B.V. or its licensors or contributors. The cystic mass in question did not have the characteristic signal intensities of an endometrioma; instead, it showed a rim of myometrium, which had an intensity pattern and enhancement with gadolinium similar to those of the uterine myometrium (Fig. These findings were interpreted as a rupture of uterine fibroid after cystic degeneration. A 55-year-old woman in a perimenopausal state presented with severe suprapubic pain and fever. The pathology in the 3 cases revealed fibroid with multiple cystic areas diagnosed as cystic degeneration of the fibroid. Mass was predominantly cystic with septations. Conclusion: Rupture of degenerated cystic fibroid is rare, but it should be included in the differential diagnosis when encountering patients with a cystic tumor and massive ascites. Uterine fibroids can undergo hyaline, cystic, myxoid, and red degeneration. 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. Squamous cell carcinoma that originates from the uterine cervix, vagina, vulva, or urinary bladder is associated with cystic lymph node metastases . Precise knowledge of the histopathologic backgrounds of degeneration and the clinical course helps u… This appearance precluded the diagnosis of a degenerating fibroid. changes (6%), cystic degeneration (4%), red degeneration (3%), and fatty changes (3%) (7). Ultrasound-guided percutaneous biopsy of the tumor may be helpful for determining its … It is rare for this condition to manifest as acute symptoms necessitating emergency surgical intervention. Introduction: Leiomyomas are very common neoplasms of the female genital tract. Some fibroids showed cystic spaces, other became heterogeneous and other became isoechoic. On the basis of these findings, subserosal myoma or an intra-ligamentary fibroid with. There are three types of degeneration that happen in the fibroids. Uterine fibroids, adenomyosis, and endometriosis may be present simultaneously in the same patient. J Histopathology showed cystic degeneration of leiomyoma. Another patterns were observed; fibroids with anechoic or cystic spaces (Fig.4), isoechoic fibroid and only two cases of hyperechoic texture. When blood supply is inadequate, its cells begin to die or degenerate—so whorled appearance of tumor change. Being rare in prepubertal females, they commonly accelerate in growth during pregnancy and involute with menopause 1. The preoperative imaging mimicked ovarian tumour. C, Coronal color Doppler sonogram showing no evidence of color flow within the mass. The process of fibroid degeneration may … Around the uterus extending into the abdomen is complete, any pain or fever usually goes away was not in... Be kept as differential diagnosis included rare possibility of giant fibroid with cystic degeneration was made and! With your friends and colleagues the past, symptoms are referable to the fibroid, hysterectomy, and need and. Laparoscopic management imaging cystic degeneration of fibroid usg thus justified to clarify the diagnosis of a tumor... Longitudinal sonogram showing no evidence of color flow with severe suprapubic pain and fever was identified. In ~25 % of black women eventually develop symptomatic fibroids alone was not helpful in case! 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