Presentation
Menorrhagia. Suspected cervical fibroid on prior ultrasound.
Patient Data
A pedunculated intracavity fibroid is present, measuring 2.8 x 3.2 cm transverse dimensions and 6.4 cm length (including pedicle). The pedicle arises from the anterior uterine body, and measures 0.7 cm transverse diameter. The inferior margin of the fibroid abuts the internal os. It corresponds with the suspected cervical fibroid seen on ultrasound.
Focal junctional zone thickening at the anterior aspect of the fundus, 19 mm depth, demonstrating small cystic spaces, consistent with focal adenomyosis. It corresponds with the suspected intramural fibroid seen on ultrasound.
The uterus is normal in size for parous state. C-section scar. No endometrial lesion.
The ovaries contain multiple simple cysts consistent with physiologic follicles, largest on the right measuring 18 mm. No adnexal cysts or masses. Trace of pelvic free fluid, likely physiologic.
No pelvic lymphadenopathy. No destructive bony lesion.
IMPRESSION:
2.8 x 3.2 x 6.4 cm pedunculated intracavitary fibroid. Given history of menorrhagia, gynecology referral regarding possibility of hysteroscopic resection is recommended
focal adenomyosis
Case Discussion
An intracavitary fibroid (or leiomyoma) is a submucosal fibroid which lies completely within the endometrial cavity (FIGO type 0). Commonest presenting symptom is menorrhagia. They may also present with dysmenorrhea, infertility, or as a palpable mass on vaginal examination.
Hysteroscopic myomectomy is typically the preferred treatment for intracavitary fibroids. Uterine fibroid embolization is effective but carries an increased risk of fibroid expulsion, and potentially associated bleeding or sepsis.
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