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

Thank You