Presentation
Pelvic pain with metrorrhagia.
Patient Data
Large pedunculated slightly hypoechoic relatively homogeneous mass prolapsing into vagina through an enlarged cervical canal. Small intramural hypoechoic leiomyomas are also noted.
There is a large well-defined pedunculated intracavitary mass measuring 8.5 x 7.5 x 7 cm, with a long stalk arising from the fundus, filling the uterine cavity and prolapsing into the vagina through a distended endocervical canal. It elicits an intermediate signal on T1, slight high signal on T2 with a homogeneous enhancement on postcontrast sequences. The vascular pedicle is well-visualized on T2 sequences.
Numerous intramural leiomyomas of various size are noted ranging from 1.5 to 4 cm (Figo 4, 5, and 6).
Case Discussion
MRI features of a pedunculated endometrial polyp prolapsing into vagina with numerous intramural leiomyomas.
MRI is the most reliable imaging technique for detection of the number, size as well as location of the uterine leiomyomas, and rule out in such case a prolapsed leiomyoma or neoplasm of the cervix extending to the upper vagina.