Presentation
Married woman with bleeding.
Patient Data
A large pelviabdominal mass lesion is arising from the anterior uterine wall with bridging vessels arising from the uterus to the mass. The lesion elicits a high signal on T2 WI (evident along its upper part), likely rerenting myxoid material on a background of low signal (non-myxoid components). It measures about 16x12.6x19 cm along its mas axial and CC dimensions.
No adenxal cystic or solid masses.
Conclusion: Large uterine fibroid with possible myxoid degeneration.
The mass shows mild increased FDG uptake with SUVmax 4. It shows cystic-like low density along its upper part with internal septations.
No other metabolically active lesions were distinctive for neoplasia.
Pathology after excision myxoid degeneration of fibroid.
Case Discussion
Myxoid and hydropic degeneration of fibroids may mimic ovarian cysts secondary to their high T2 signal, however, in our case, bridging vessels confirmed the uterine origin of the lesion. Also, its high signal on T2 on a background of low signal suggested myxoid degeneration of the fibroid, which was confirmed pathologically after excision.
Myxoid degeneration of leiomyoma is one of the rarer types of degeneration that can occur in a uterine leiomyoma.
Fibroids that have undergone myxoid degeneration are filled with a gelatinous material and are hard to distinguish from uterine cystic degeneration; however, they typically appear as more complex cystic masses. They appear hypocellular with a myxoid matrix.
On MRI, it shows
- T1: low signal intensity
- T2: usually high signal intensity on a background of low T2 signal (non-myxoid components) with a peripheral low signal intensity
- T1 C+ (Gd): there is minimal or no enhancement
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