Fibroids and Adenomyosis Dr.Aftab Qadir
Fibroids and Adenomyosis
Dr.Aftab Qadir
1.Uterine leiomyoma
Benign tumours of myometrium
Most common solid benign uterine
neoplasm
~25% of women of reproductive age
Responsive to hormones
Often asymptomatic
Menorrhagia
Pain
Infertility
Palpable mass
Radiographic features
Conventional radiography
Popcorn calcification or peripheral rim of calcification
Displacement of bowel gas by a pelvic mass
Ultrasound
Usually hypoechoic, but can be isoechoic, or even hyperechoic
Calcification
Cystic areas of necrosis or degeneration
CT
Usually of soft tissue density
May exhibit coarse peripheral or
central calcification
May distort the usually smooth uterine
contour
Enhancement pattern is variable
Pelvic MRI
Low to intermediate signal intensity
on T1 and T2 weighted images
compared with the normal
myometrium
High central signal intensity on T2
from hemorrhage
Complications
Malignant degeneration
into leiomyosarcomas
May torse, leading to acute pelvic pain
Pregnancy may cause fibroid growth
Differential diagnosis
Uterine leiomyosarcoma
Uterine lipoleiomyoma
Ovarian masses
Focal myometrial contraction during
pregnancy
Focal adenomyosis
2.Adenomyosis
Ectopic endometrial tissue in the
myometrium
Spectrum of endometriosis
Women of reproductive age
Higher frequency history of surgical
uterine procedures
Symptomatic:
Menorrhagia and dysmenorrhea
May present with chronic pelvic pain
In 20% of cases is associated with co-
existent endometriosis
Types
Diffuse adenomyosis: most common
Focal adenomyosis
Cystic adenomyosis: rare
Ultrasound
Sonographic features are variable.
Normal appearing uterus
Focal or diffuse myometrial bulkiness, typically of the posterior wall
Thickening of the transition zone
Subendometrial echogenic linear striations
Subendometrial echogenic nodules
Small myometrial cysts / sub endometrial cysts
Heterogeneous myometrial echotexture
Hysterosalpingogram (HSG)
May show diverticula extending into
the myometrium
CT
May suggest its presence when
uterine enlargement is present.
Distinguishing between adenomyosis
and uterine fibroids is difficult
Pelvic MRI
Modality of choice to diagnose
and characterise adenomyosis
T2 weighted images are most useful
Thickening of the junctional zone of
the uterus to more than 12 mm
T2
◦ Appears as an ill-defined focal/diffuse
region of thickening, often with small high
T2 signal regions representing small
regions of cystic change
T1
◦ Foci of high T1 signal are often seen
Differences on sonography
Few cases
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