IS Case 75: Uterine Leiomyoma

Sara Ann Majewski, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-19


Patient is a 42-year-old female complaining of heavy vaginal bleeding. Gynecologic exam revealed a mass protruding through the cervix. This mass was imaged on ultrasound and later removed.


Vascular, hypoechoic tissue extending into the cervix and connecting to the endometrium which most likely represents a fibroid. Differential diagnoses include polyp or malignancy.


Uterine Leiomyoma


The cervix is best visualized transvaginally.

Differential diagnosis of a mass protruding through the cervix includes cervical polyps, leiomyomas, cervical stump pseudomass, cervical carcinoma and adenoma malignum.

Cervical polyps frequently cause vaginal bleeding and are typically a clinical diagnosis.

About eight percent of leiomyomas develop in the cervix and can be pedunculated, prolapsing into the vagina.

After hysterectomy, the cervical stump can look like a mass and can be evaluated by transvaginal sonography.

Cervical carcinoma is usually diagnosed clinically, but sonography can show a solid mass posterior to the bladder which can be indistinguishable from a cervical fibroid. CT and MRI are used for staging purposes.

Adenoma malignum is a rare cervical neoplasm developing from the endocervical glands. In many cases, this is associated with Peutz-Jeghers. Numerous cystic areas are seen in a solid cervical mass. This is different from nabothian cysts which have no associated mass.


  1. Rumack C, Wilson S, Charboneau JW, Johnson J-A. Diagnostic Ultrasound. 3rd ed., St. Louis: Mosby, 2005.

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