Myxoid uterine leiomyoma

Case contributed by Dr Ammar Haouimi

Presentation

Vaginal bleeding with pelvic pain.

Patient Data

Age: 25 years
Gender: Female
MRI

There is a large well-circumscribed lobulated and multiloculated soft tissue mass within the myometrium of the uterine isthmus. It appears of intermediate signal intensity on T1WI with areas of high signal (cystic hemorrhage), high signal on T2WI with sediment of the low signal within the cystic areas indicating hemosiderin deposits. A peripheral rim of low signal is noted on all sequences mainly on  T2WI. The postcontrast sequences show an intense and relatively heterogeneous enhancement except for the central areas of cystic haemorrahge which remain hypointense.

Focal thickening of the posterior uterine junctional zone seen as an inhomogeneous low signal intensity on T2 (thickness=25 mm) with multiple foci of high signal intensity. Multiple punctate fibroids of low signal T2WI are noted within the myometrium. 

Both ovaries appear normal, containing follicles with minimal effusion in the pouch of Douglas.

Pathology

Macroscopically: well-limited oval mass with regular contours, measuring 7 x 6 cm, of soft consistency and translucent appearance, with areas of hemorrhagic changes.

Microscopically: This mass shows a mesenchymal proliferation with amorphous and myxoid stroma dissociating smooth muscle cells.

This myxoid and edematous material, of heterogeneous density, contains the remnants of smooth muscle cells often reduced to pale and small nuclei.
On the periphery, this proliferation of fasciculate architecture is composed of fusiform smooth muscle fibers with ill-defined limits and abundant eosinophilic cytoplasm. The nuclei are elongated with "end of cigar" appearance                                      

Conclusion: a histological aspect of a myxoid uterine leiomyoma with no histological signs of malignancy.

Case Discussion

MRI features of myxoid uterine leiomyoma with an associated focal adenomyosis

Myxoid uterine leiomyoma is a rare pathological entity of uterine leiomyoma and should not be confused with myxoid degeneration of uterine leiomyoma.

On MR imaging a uterine leiomyosarcoma should be considered in the differential diagnosis.

 

Additional contributor: Selma Nezar, MD histopathologist Batna, Algeria

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Case information

rID: 65056
Published: 11th Jan 2019
Last edited: 12th Jan 2019
System: Gynaecology
Inclusion in quiz mode: Included
Institution: Aurès Medical Imaging Center - Batna Algeria

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