Subserous fibroid

Case contributed by Mostafa Elfeky
Diagnosis almost certain


Pelvic pain and heaviness.

Patient Data

Age: 40 years
Gender: Female



A sizable well-defined smooth outlined pelvi-abdominal mass lesion, epicentered on the left postero-lateral aspect of the uterine body, averages around 14 x 13 x 8 cm in dimensions. It shows heterogeneous signal of mainly T2 isointense whorls of muscle fascicles with intervening mild edema and few cystic crypts.  

Multiple signal voids of marked vascularity seen bridging into the lesions from the left uterine artery branches via a narrow pedicle of 3 cm. This is associated with pelvic varices, notably on the left.

Marked mass effect is noted in the form of effacement of the uterine body inferiorly and the rectum posteriorly and the rest of the abdominal organs notably the small and large intestinal bowel loops upwards, all are seen separable from the index lesion showing normal features.

Case Discussion

Features collectively are impressive of a sizable subserosal fibroid. Mild fibroid edema and few cystic crypts seen may reflect early degeneration. The large size of the lesion increases the possibility of sarcomatous changes. This is considered type 6 fibroid according to FIGO classification 1.

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