Sub-mucosal leiomyoma of the uterus

A submucosal leiomyoma of the uterus refers to a subtype of uterine leiomyoma that primarily projects into the endometrial cavity. They are least common albeit the most symptomatic type of leiomyoma.

Clinical presentation

Submucosal leiomyomas can be a common source of abnormal uterine bleeding and may also present with reproductive dysfunction, including recurrent miscarriages, infertility, premature labour and/or fetal malpresentation. 

Pathology

Associations

Radiographic features

General

It is typically seen as a subendometrial mass indenting and distorting the endometrium.

Ultrasound 

On ultrasound, submucosal fibroids are typically seen as broad-based, hypo-echoic, well-defined, solid masses with shadowing. Submucosal fibroids typically have an overlying layer of the echogenic endometrium, which helps confirm their subendometrial location and helps distinguish them from endometrial polyps. In addition, as opposed to polyps, submucosal fibroids often distort the interface between the endometrium and myometrium and show acoustic attenuation.

MRI
  • T2: typical homogenous hypointensity is seen. 
    • atypical findings may include hyperintensity due to edema.

Differential diagnosis

General imaging differential considerations include

See also

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Article Information:

rID: 14954
System: Gynaecology
Tag: cases
Synonyms or Alternate Spellings:
  • Submucosal leiomyoma
  • Sub-mucosal fibroid
  • Sub-mucosal fibroids
  • Submucosal fibroids
  • Submucosal fibroid
  • Sub-mucosal uterine leiomyoma
  • Sub mucosal uterine leiomyoma
  • Submucosal uterine leiomyoma
  • Submucosal uterine fibroid
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    Case 1: projecting into the endometrial cavity on a HSG
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    Case 2: prolapsing uterine leiomyoma
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    Case 3: submucosal leiomyoma on ultrasound
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    Case 4: on single contrast HSG
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