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Unusual Appearances of Uterine Leiomyomas: MR Imaging Findings and Their Histopathologic Backgrounds¹

¹ From the Departments of Nuclear Medicine and Diagnostic Imaging (H.U., M.L.K., T.K., T.F., J.K.), Diagnostic and Interventional Imageology (K.T., H.K.), and Gynecology and Obstetrics (I.K., S.F.), Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. Recipient of a Certificate of Merit award for a scientific exhibit at the 1998 RSNA scientific assembly. Received February 2, 1999; revision requested March 3; final revision received April 26; accepted April 29. Address reprint requests to K.T.

View larger version (168K): [in a new window]   Figure 1a.   Typical leiomyoma in a 37-year-old woman. (a) Sagittal spin-echo T2-weighted MR image (2,000/70 [repetition time msec/echo time msec]) shows a well-demarcated mass of distinct low signal intensity with a speckled appearance. (b) Photograph of the cut surface of the resected lesion shows a white mass with a speckled appearance. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows hyaline degeneration throughout the lesion (*).

View larger version (162K): [in a new window]   Figure 1b.   Typical leiomyoma in a 37-year-old woman. (a) Sagittal spin-echo T2-weighted MR image (2,000/70 [repetition time msec/echo time msec]) shows a well-demarcated mass of distinct low signal intensity with a speckled appearance. (b) Photograph of the cut surface of the resected lesion shows a white mass with a speckled appearance. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows hyaline degeneration throughout the lesion (*).

View larger version (196K): [in a new window]   Figure 1c.   Typical leiomyoma in a 37-year-old woman. (a) Sagittal spin-echo T2-weighted MR image (2,000/70 [repetition time msec/echo time msec]) shows a well-demarcated mass of distinct low signal intensity with a speckled appearance. (b) Photograph of the cut surface of the resected lesion shows a white mass with a speckled appearance. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows hyaline degeneration throughout the lesion (*).

View larger version (154K): [in a new window]   Figure 2a.   Subserosal leiomyoma with extensive cystic degeneration in a 61-year-old woman. (a, b) Sagittal spin-echo T1-weighted (600/25) (a) and T2-weighted (2,000/70) (b) MR images show a mass posterior to the uterus (U) (arrows). The signal intensity of the mass corresponds to fluid mixed with thin, interlacing tissue of intermediate signal intensity on both images. (c) Photograph of the cut surface of the resected lesion shows an almost entirely cystic mass with scanty solid tissue. (Reprinted, with permission, from reference 4.)

View larger version (159K): [in a new window]   Figure 2b.   Subserosal leiomyoma with extensive cystic degeneration in a 61-year-old woman. (a, b) Sagittal spin-echo T1-weighted (600/25) (a) and T2-weighted (2,000/70) (b) MR images show a mass posterior to the uterus (U) (arrows). The signal intensity of the mass corresponds to fluid mixed with thin, interlacing tissue of intermediate signal intensity on both images. (c) Photograph of the cut surface of the resected lesion shows an almost entirely cystic mass with scanty solid tissue. (Reprinted, with permission, from reference 4.)

View larger version (142K): [in a new window]   Figure 2c.   Subserosal leiomyoma with extensive cystic degeneration in a 61-year-old woman. (a, b) Sagittal spin-echo T1-weighted (600/25) (a) and T2-weighted (2,000/70) (b) MR images show a mass posterior to the uterus (U) (arrows). The signal intensity of the mass corresponds to fluid mixed with thin, interlacing tissue of intermediate signal intensity on both images. (c) Photograph of the cut surface of the resected lesion shows an almost entirely cystic mass with scanty solid tissue. (Reprinted, with permission, from reference 4.)

View larger version (149K): [in a new window]   Figure 3a.   Leiomyoma with myxoid degeneration in a 55-year-old woman. (a-c) Sagittal spin-echo T2-weighted (2,000/70) (a), T1-weighted (600/20) (b), and gadolinium-enhanced T1-weighted (600/20) (c) MR images show a mass arising from the uterine cervix that has mixed solid and cystic components. Myxoid material (arrowheads) demonstrates high signal intensity on the T2-weighted image (a), low signal intensity on the T1-weighted image (b), and no enhancement on the gadolinium-enhanced image (c). Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). (d) Photograph of the cut surface of the resected lesion shows a cystic mass filled with gelatinous material (arrowheads).

View larger version (151K): [in a new window]   Figure 3b.   Leiomyoma with myxoid degeneration in a 55-year-old woman. (a-c) Sagittal spin-echo T2-weighted (2,000/70) (a), T1-weighted (600/20) (b), and gadolinium-enhanced T1-weighted (600/20) (c) MR images show a mass arising from the uterine cervix that has mixed solid and cystic components. Myxoid material (arrowheads) demonstrates high signal intensity on the T2-weighted image (a), low signal intensity on the T1-weighted image (b), and no enhancement on the gadolinium-enhanced image (c). Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). (d) Photograph of the cut surface of the resected lesion shows a cystic mass filled with gelatinous material (arrowheads).

View larger version (155K): [in a new window]   Figure 3c.   Leiomyoma with myxoid degeneration in a 55-year-old woman. (a-c) Sagittal spin-echo T2-weighted (2,000/70) (a), T1-weighted (600/20) (b), and gadolinium-enhanced T1-weighted (600/20) (c) MR images show a mass arising from the uterine cervix that has mixed solid and cystic components. Myxoid material (arrowheads) demonstrates high signal intensity on the T2-weighted image (a), low signal intensity on the T1-weighted image (b), and no enhancement on the gadolinium-enhanced image (c). Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). (d) Photograph of the cut surface of the resected lesion shows a cystic mass filled with gelatinous material (arrowheads).

View larger version (130K): [in a new window]   Figure 3d.   Leiomyoma with myxoid degeneration in a 55-year-old woman. (a-c) Sagittal spin-echo T2-weighted (2,000/70) (a), T1-weighted (600/20) (b), and gadolinium-enhanced T1-weighted (600/20) (c) MR images show a mass arising from the uterine cervix that has mixed solid and cystic components. Myxoid material (arrowheads) demonstrates high signal intensity on the T2-weighted image (a), low signal intensity on the T1-weighted image (b), and no enhancement on the gadolinium-enhanced image (c). Viable tissue has relatively low signal intensity on the T2-weighted image (a) and is well enhanced on the gadolinium-enhanced image (c). (d) Photograph of the cut surface of the resected lesion shows a cystic mass filled with gelatinous material (arrowheads).

View larger version (169K): [in a new window]   Figure 4a.   Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. (a) Sagittal fast spin-echo T2-weighted MR image (5,000/100) obtained several hours after onset shows a thick rim of distinct low signal intensity that corresponds to acute hemorrhage (arrows). (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows complete absence of enhancement, a finding that indicates infarction. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. (f,g)Permission to reprint these figures electronically was denied by the publisher. See print version.

View larger version (139K): [in a new window]   Figure 4b.   Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. (a) Sagittal fast spin-echo T2-weighted MR image (5,000/100) obtained several hours after onset shows a thick rim of distinct low signal intensity that corresponds to acute hemorrhage (arrows). (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows complete absence of enhancement, a finding that indicates infarction. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. (f,g)Permission to reprint these figures electronically was denied by the publisher. See print version.

View larger version (146K): [in a new window]   Figure 4c.   Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. (a) Sagittal fast spin-echo T2-weighted MR image (5,000/100) obtained several hours after onset shows a thick rim of distinct low signal intensity that corresponds to acute hemorrhage (arrows). (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows complete absence of enhancement, a finding that indicates infarction. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. (f,g)Permission to reprint these figures electronically was denied by the publisher. See print version.

View larger version (168K): [in a new window]   Figure 4d.   Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. (a) Sagittal fast spin-echo T2-weighted MR image (5,000/100) obtained several hours after onset shows a thick rim of distinct low signal intensity that corresponds to acute hemorrhage (arrows). (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows complete absence of enhancement, a finding that indicates infarction. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. (f,g)Permission to reprint these figures electronically was denied by the publisher. See print version.

View larger version (140K): [in a new window]   Figure 4e.   Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. (a) Sagittal fast spin-echo T2-weighted MR image (5,000/100) obtained several hours after onset shows a thick rim of distinct low signal intensity that corresponds to acute hemorrhage (arrows). (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows complete absence of enhancement, a finding that indicates infarction. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. (f,g)Permission to reprint these figures electronically was denied by the publisher. See print version.

View larger version (0K): [in a new window]   Figure 4f.   Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. (a) Sagittal fast spin-echo T2-weighted MR image (5,000/100) obtained several hours after onset shows a thick rim of distinct low signal intensity that corresponds to acute hemorrhage (arrows). (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows complete absence of enhancement, a finding that indicates infarction. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. (f,g)Permission to reprint these figures electronically was denied by the publisher. See print version.

View larger version (0K): [in a new window]   Figure 4g.   Red degeneration in a 44-year-old woman with sudden onset of abdominal pain. (a) Sagittal fast spin-echo T2-weighted MR image (5,000/100) obtained several hours after onset shows a thick rim of distinct low signal intensity that corresponds to acute hemorrhage (arrows). (b) Sagittal spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows no significant findings. (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/13) obtained several hours after onset shows complete absence of enhancement, a finding that indicates infarction. (d, e) Sagittal fast spin-echo T2-weighted (5,500/100) (d) and spin-echo T1-weighted (600/13) (e) MR images obtained 1 week later show a thick rim of distinct low signal intensity on the T2-weighted image (arrows in d) and high signal intensity on the T1-weighted image (arrows in e) that corresponds to subacute hemorrhage. (f,g)Permission to reprint these figures electronically was denied by the publisher. See print version.

View larger version (169K): [in a new window]   Figure 5a.   Leiomyoma consisting of a cellular component and peripheral edema in a 45-year-old woman. (a) Sagittal T2-weighted spin-echo MR image (2,000/70) shows a mass of intermediate signal intensity with a high-signal-intensity periphery (arrows). (b, c) Photomicrographs (original magnification, x20; hematoxylin-eosin stain) show tightly packed smooth muscle cells in the central zone (b) and prominent edema with large vessels at the periphery (c).

View larger version (227K): [in a new window]   Figure 5b.   Leiomyoma consisting of a cellular component and peripheral edema in a 45-year-old woman. (a) Sagittal T2-weighted spin-echo MR image (2,000/70) shows a mass of intermediate signal intensity with a high-signal-intensity periphery (arrows). (b, c) Photomicrographs (original magnification, x20; hematoxylin-eosin stain) show tightly packed smooth muscle cells in the central zone (b) and prominent edema with large vessels at the periphery (c).

View larger version (204K): [in a new window]   Figure 5c.   Leiomyoma consisting of a cellular component and peripheral edema in a 45-year-old woman. (a) Sagittal T2-weighted spin-echo MR image (2,000/70) shows a mass of intermediate signal intensity with a high-signal-intensity periphery (arrows). (b, c) Photomicrographs (original magnification, x20; hematoxylin-eosin stain) show tightly packed smooth muscle cells in the central zone (b) and prominent edema with large vessels at the periphery (c).

View larger version (167K): [in a new window]   Figure 6a.   Leiomyoma with extensive edema in a 25-year-old woman. (a) Sagittal spin-echo T2-weighted MR image (2,000/70) shows a large mass of high signal intensity with scattered foci of low signal intensity arising from the uterus. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/20) show prominent enhancement of the entire mass except for small foci of cystic changes. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. (e) Photomicrograph (original magnification, x20; hematoxylin-eosin stain) shows sparse smooth muscle cells (arrows) scattered within an area of extensive edema (*). No hyalin is present.

View larger version (177K): [in a new window]   Figure 6b.   Leiomyoma with extensive edema in a 25-year-old woman. (a) Sagittal spin-echo T2-weighted MR image (2,000/70) shows a large mass of high signal intensity with scattered foci of low signal intensity arising from the uterus. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/20) show prominent enhancement of the entire mass except for small foci of cystic changes. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. (e) Photomicrograph (original magnification, x20; hematoxylin-eosin stain) shows sparse smooth muscle cells (arrows) scattered within an area of extensive edema (*). No hyalin is present.

View larger version (159K): [in a new window]   Figure 6c.   Leiomyoma with extensive edema in a 25-year-old woman. (a) Sagittal spin-echo T2-weighted MR image (2,000/70) shows a large mass of high signal intensity with scattered foci of low signal intensity arising from the uterus. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/20) show prominent enhancement of the entire mass except for small foci of cystic changes. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. (e) Photomicrograph (original magnification, x20; hematoxylin-eosin stain) shows sparse smooth muscle cells (arrows) scattered within an area of extensive edema (*). No hyalin is present.

View larger version (134K): [in a new window]   Figure 6d.   Leiomyoma with extensive edema in a 25-year-old woman. (a) Sagittal spin-echo T2-weighted MR image (2,000/70) shows a large mass of high signal intensity with scattered foci of low signal intensity arising from the uterus. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/20) show prominent enhancement of the entire mass except for small foci of cystic changes. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. (e) Photomicrograph (original magnification, x20; hematoxylin-eosin stain) shows sparse smooth muscle cells (arrows) scattered within an area of extensive edema (*). No hyalin is present.

View larger version (208K): [in a new window]   Figure 6e.   Leiomyoma with extensive edema in a 25-year-old woman. (a) Sagittal spin-echo T2-weighted MR image (2,000/70) shows a large mass of high signal intensity with scattered foci of low signal intensity arising from the uterus. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/20) show prominent enhancement of the entire mass except for small foci of cystic changes. (d) Photograph of the cut surface of the resected lesion shows a soft, pink mass. (e) Photomicrograph (original magnification, x20; hematoxylin-eosin stain) shows sparse smooth muscle cells (arrows) scattered within an area of extensive edema (*). No hyalin is present.

View larger version (161K): [in a new window]   Figure 7a.   Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image (6,000/126) shows a mass of relatively low signal intensity. Hemorrhage and necrosis are not obvious. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/9) show irregular areas of necrosis (arrows). The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows).

View larger version (154K): [in a new window]   Figure 7b.   Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image (6,000/126) shows a mass of relatively low signal intensity. Hemorrhage and necrosis are not obvious. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/9) show irregular areas of necrosis (arrows). The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows).

View larger version (156K): [in a new window]   Figure 7c.   Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image (6,000/126) shows a mass of relatively low signal intensity. Hemorrhage and necrosis are not obvious. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/9) show irregular areas of necrosis (arrows). The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows).

View larger version (156K): [in a new window]   Figure 7d.   Cellular leiomyoma with coagulative necrosis in a 44-year-old woman. (a) Sagittal fast spin-echo T2-weighted MR image (6,000/126) shows a mass of relatively low signal intensity. Hemorrhage and necrosis are not obvious. (b, c) Sagittal nonenhanced (b) and gadolinium-enhanced (c) spin-echo T1-weighted MR images (600/9) show irregular areas of necrosis (arrows). The necrotic areas have high signal intensity on the T1-weighted image (b) and demonstrate no enhancement on the gadolinium-enhanced image (c). (d) Photograph of the cut surface of the resected lesion shows a fleshy mass with focal hemorrhage (arrows).

View larger version (179K): [in a new window]   Figure 8a.   Leiomyoma with ring calcification (probably a sequela of red degeneration) in a 42-year-old woman. The patient had experienced acute abdominal symptoms during her last pregnancy, which were indicative of red degeneration. (a, b) Sagittal fast spin-echo T2-weighted (6,000/126) (a) and spin-echo T1-weighted (600/9) (b) MR images show a mass with a distinct rim of low signal intensity (arrowheads). (c) Gadolinium-enhanced spin-echo T1-weighted MR image (600/9) shows complete absence of enhancement.

View larger version (157K): [in a new window]   Figure 8b.   Leiomyoma with ring calcification (probably a sequela of red degeneration) in a 42-year-old woman. The patient had experienced acute abdominal symptoms during her last pregnancy, which were indicative of red degeneration. (a, b) Sagittal fast spin-echo T2-weighted (6,000/126) (a) and spin-echo T1-weighted (600/9) (b) MR images show a mass with a distinct rim of low signal intensity (arrowheads). (c) Gadolinium-enhanced spin-echo T1-weighted MR image (600/9) shows complete absence of enhancement.

View larger version (181K): [in a new window]   Figure 8c.   Leiomyoma with ring calcification (probably a sequela of red degeneration) in a 42-year-old woman. The patient had experienced acute abdominal symptoms during her last pregnancy, which were indicative of red degeneration. (a, b) Sagittal fast spin-echo T2-weighted (6,000/126) (a) and spin-echo T1-weighted (600/9) (b) MR images show a mass with a distinct rim of low signal intensity (arrowheads). (c) Gadolinium-enhanced spin-echo T1-weighted MR image (600/9) shows complete absence of enhancement.

View larger version (126K): [in a new window]   Figure 9a.   Lipoleiomyoma in a 76-year-old woman. (a-c) Sagittal fast spin-echo T2-weighted (3,000/120) (a) and spin-echo T1-weighted (400/25) (b) MR images and gadolinium-enhanced spin-echo T1-weighted MR image (400/25) obtained with fat suppression (c) show a mass (arrows) with signal intensity equal to that of subcutaneous fat. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. (e) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. (Fig 9a-9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan.)

View larger version (138K): [in a new window]   Figure 9b.   Lipoleiomyoma in a 76-year-old woman. (a-c) Sagittal fast spin-echo T2-weighted (3,000/120) (a) and spin-echo T1-weighted (400/25) (b) MR images and gadolinium-enhanced spin-echo T1-weighted MR image (400/25) obtained with fat suppression (c) show a mass (arrows) with signal intensity equal to that of subcutaneous fat. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. (e) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. (Fig 9a-9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan.)

View larger version (141K): [in a new window]   Figure 9c.   Lipoleiomyoma in a 76-year-old woman. (a-c) Sagittal fast spin-echo T2-weighted (3,000/120) (a) and spin-echo T1-weighted (400/25) (b) MR images and gadolinium-enhanced spin-echo T1-weighted MR image (400/25) obtained with fat suppression (c) show a mass (arrows) with signal intensity equal to that of subcutaneous fat. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. (e) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. (Fig 9a-9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan.)

View larger version (130K): [in a new window]   Figure 9d.   Lipoleiomyoma in a 76-year-old woman. (a-c) Sagittal fast spin-echo T2-weighted (3,000/120) (a) and spin-echo T1-weighted (400/25) (b) MR images and gadolinium-enhanced spin-echo T1-weighted MR image (400/25) obtained with fat suppression (c) show a mass (arrows) with signal intensity equal to that of subcutaneous fat. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. (e) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. (Fig 9a-9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan.)

View larger version (221K): [in a new window]   Figure 9e.   Lipoleiomyoma in a 76-year-old woman. (a-c) Sagittal fast spin-echo T2-weighted (3,000/120) (a) and spin-echo T1-weighted (400/25) (b) MR images and gadolinium-enhanced spin-echo T1-weighted MR image (400/25) obtained with fat suppression (c) show a mass (arrows) with signal intensity equal to that of subcutaneous fat. (d) Photograph of the cut surface of the resected lesion shows a soft, yellow mass. (e) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows numerous adipocytes in the mass. (Fig 9a-9e courtesy of Tsuyoshi Itoh, MD, Kyoto National Hospital, Kyoto, Japan.)

View larger version (122K): [in a new window]   Figure 10a.   Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-year-old woman. (a, b) Sagittal spin-echo T2-weighted (2,000/70) (a) and T1-weighted (600/20) (b) MR images show a huge mass with signal intensity similar to that of fluid: high on the T2-weighted image (a) and low on the T1-weighted image (b). (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/20) shows prominent enhancement of the lesion except for small foci of mucinous lakes (arrowheads). (d) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows nuclear atypia. Smooth muscle cells are so widely separated by abundant myxoid material that mitotic count and cellularity cannot be assessed precisely.

View larger version (112K): [in a new window]   Figure 10b.   Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-year-old woman. (a, b) Sagittal spin-echo T2-weighted (2,000/70) (a) and T1-weighted (600/20) (b) MR images show a huge mass with signal intensity similar to that of fluid: high on the T2-weighted image (a) and low on the T1-weighted image (b). (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/20) shows prominent enhancement of the lesion except for small foci of mucinous lakes (arrowheads). (d) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows nuclear atypia. Smooth muscle cells are so widely separated by abundant myxoid material that mitotic count and cellularity cannot be assessed precisely.

View larger version (128K): [in a new window]   Figure 10c.   Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-year-old woman. (a, b) Sagittal spin-echo T2-weighted (2,000/70) (a) and T1-weighted (600/20) (b) MR images show a huge mass with signal intensity similar to that of fluid: high on the T2-weighted image (a) and low on the T1-weighted image (b). (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/20) shows prominent enhancement of the lesion except for small foci of mucinous lakes (arrowheads). (d) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows nuclear atypia. Smooth muscle cells are so widely separated by abundant myxoid material that mitotic count and cellularity cannot be assessed precisely.

View larger version (203K): [in a new window]   Figure 10d.   Myxoid leiomyoma (smooth muscle tumor of uncertain malignant potential) in a 50-year-old woman. (a, b) Sagittal spin-echo T2-weighted (2,000/70) (a) and T1-weighted (600/20) (b) MR images show a huge mass with signal intensity similar to that of fluid: high on the T2-weighted image (a) and low on the T1-weighted image (b). (c) Sagittal gadolinium-enhanced spin-echo T1-weighted MR image (600/20) shows prominent enhancement of the lesion except for small foci of mucinous lakes (arrowheads). (d) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows nuclear atypia. Smooth muscle cells are so widely separated by abundant myxoid material that mitotic count and cellularity cannot be assessed precisely.

View larger version (164K): [in a new window]   Figure 11a.   Intravenous leiomyomatosis in a 44-year-old woman. (a, b) Sagittal fast spin-echo T2-weighted MR images (6,000/135) show an ill-defined, subserosal mass of low signal intensity (arrows in a) with multiple wormlike projections that extensively involve the myometrium, parametrium, adnexa, and gonadal veins (large arrowheads in a, arrowheads in b). The wormlike projections are accompanied by prominent signal voids (small arrowheads in a). (c) Photograph of the resected specimen shows the subserosal tumor (arrows) and wormlike projections (arrowheads).

View larger version (173K): [in a new window]   Figure 11b.   Intravenous leiomyomatosis in a 44-year-old woman. (a, b) Sagittal fast spin-echo T2-weighted MR images (6,000/135) show an ill-defined, subserosal mass of low signal intensity (arrows in a) with multiple wormlike projections that extensively involve the myometrium, parametrium, adnexa, and gonadal veins (large arrowheads in a, arrowheads in b). The wormlike projections are accompanied by prominent signal voids (small arrowheads in a). (c) Photograph of the resected specimen shows the subserosal tumor (arrows) and wormlike projections (arrowheads).

View larger version (117K): [in a new window]   Figure 11c.   Intravenous leiomyomatosis in a 44-year-old woman. (a, b) Sagittal fast spin-echo T2-weighted MR images (6,000/135) show an ill-defined, subserosal mass of low signal intensity (arrows in a) with multiple wormlike projections that extensively involve the myometrium, parametrium, adnexa, and gonadal veins (large arrowheads in a, arrowheads in b). The wormlike projections are accompanied by prominent signal voids (small arrowheads in a). (c) Photograph of the resected specimen shows the subserosal tumor (arrows) and wormlike projections (arrowheads).

View larger version (167K): [in a new window]   Figure 12.   Leiomyoma with extensive intraligamental growth in a 55-year-old woman. Axial fast spin-echo T2-weighted MR image (6,000/86.8) shows anterior displacement of the descending colon (arrowheads) by a mass (arrows). Although the lesion appears to be a retroperitoneal tumor, surgery demonstrated a leiomyoma growing into the retroperitoneum within the broad ligament.

View larger version (150K): [in a new window]   Figure 13a.   Leiomyoma attached to the fallopian tube in a 32-year-old woman. Axial spin-echo T2-weighted (2,000/70) (a) and gadolinium-enhanced T1-weighted (600/20) (b) MR images show a mass (arrows), which demonstrates high signal intensity on the T2-weighted image (a) and heterogeneous enhancement on the gadolinium-enhanced image (b). This myxoid leiomyoma had a blood supply only from the fallopian tube and was considered to be a parasitic growth, although this fact was not clear at MR imaging.

View larger version (163K): [in a new window]   Figure 13b.   Leiomyoma attached to the fallopian tube in a 32-year-old woman. Axial spin-echo T2-weighted (2,000/70) (a) and gadolinium-enhanced T1-weighted (600/20) (b) MR images show a mass (arrows), which demonstrates high signal intensity on the T2-weighted image (a) and heterogeneous enhancement on the gadolinium-enhanced image (b). This myxoid leiomyoma had a blood supply only from the fallopian tube and was considered to be a parasitic growth, although this fact was not clear at MR imaging.

View larger version (161K): [in a new window]   Figure 14a.   Huge cervical leiomyoma in a 32-year-old woman. (a, b) Sagittal fast spin-echo T2-weighted (4,000/130) (a) and nonenhanced spin-echo T1-weighted (600/10) (b) MR images show a huge leiomyoma (arrows) posterior to the uterus (U). The cervical canal (arrowheads) is folded into the myoma. (c) Diagram shows the relationships between the mass (M), cervical canal (*), and uterus (u).

View larger version (141K): [in a new window]   Figure 14b.   Huge cervical leiomyoma in a 32-year-old woman. (a, b) Sagittal fast spin-echo T2-weighted (4,000/130) (a) and nonenhanced spin-echo T1-weighted (600/10) (b) MR images show a huge leiomyoma (arrows) posterior to the uterus (U). The cervical canal (arrowheads) is folded into the myoma. (c) Diagram shows the relationships between the mass (M), cervical canal (*), and uterus (u).

View larger version (9K): [in a new window]   Figure 14c.   Huge cervical leiomyoma in a 32-year-old woman. (a, b) Sagittal fast spin-echo T2-weighted (4,000/130) (a) and nonenhanced spin-echo T1-weighted (600/10) (b) MR images show a huge leiomyoma (arrows) posterior to the uterus (U). The cervical canal (arrowheads) is folded into the myoma. (c) Diagram shows the relationships between the mass (M), cervical canal (*), and uterus (u).