IS Case 75: Uterine Leiomyoma

Sara Ann Majewski, MD


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

History

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.

Findings

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

Diagnosis

Uterine Leiomyoma

Discussion

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.

References

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

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