Replies to This Discussion

Permalink Reply by Bashir H Samma;MD,PGD&C,SrMAIUM on December 11, 2010 at 2:02pm

Doc if it is not pregnancy then consider an adenomyotic cyst...I can see villous-like peripheral echoes!

 

I wish you could render tissue-color doppler map there. Thank you for sharing

Permalink Reply by Elisabeth Wegner on December 13, 2010 at 11:20am

I agree, most consistent with cystic adenomyosis, also degenerated fibroids can appear as a cyst in the myometrium

Permalink Reply by J Oscar Barahona on February 23, 2011 at 6:32pm

I also agrre with the two previous reaponces.

Permalink Reply by Dr.Muhammad Bashir Malik on March 9, 2011 at 10:41am

Dear Fellows,

In adenomyotic changes uterine shape is not so smyetrical, posterior wall is mostly thickened tahn anterior and endometrial strips gives bana shape with history of menorrhagia but not present in this case.

Most likely it seems to be necrosed intramural fibroid insted adenomyotic changes.

Permalink Reply by LESLIE BERLINSKY on June 24, 2011 at 8:24pm

hi folks, when i see cystic adenomyosis i see usually multiple small cystic spaces, a globular corpus and many times "streaky shadowing". From the appearance presented here i would cast my vote for a small necrotic  fibroid.

Permalink Reply by Dr MM Nurus shafi on June 27, 2011 at 3:19am

Thanks Leslie.

LESLIE BERLINSKY said:

hi folks, when i see cystic adenomyosis i see usually multiple small cystic spaces, a globular corpus and many times "streaky shadowing". From the appearance presented here i would cast my vote for a small necrotic  fibroid.

Permalink Reply by Lisa Koebke on July 21, 2011 at 3:51pm

Was dysmenorrhea reported?  I have seen pockets of adenomyosis that did not necessarily cause disporportion of the myometrial walls.  And, this appears more cystic to me (as in adenomyotic cyst) vs necrosis of a leiomyoma.  I also agree with the more traditional appearance of adenomyosis that Leslie reported, this may be just a more atypical presentation.

Permalink Reply by Dario Valencia on July 22, 2011 at 7:21am

This small cysttic in uterine muscle is adenomiosis because the miometriun in not glandular

Permalink Reply by Syed Amir Gilani on September 16, 2011 at 11:04am

first the answer of your question is NO NABOTHIAN GLANDS ARE PRESENT IN CERVIX THEREFORE NABOTHIAN CYSTS ARE ONLY PRESENT IN CERVIX AND CAN NOT BE SEEN IN CORPUS.

SECONDLY AS SUGGESTED BY MANY FRIENDS IF WE TAKE IT AS ADENOMYOTIC CYST-- LETS DISCUSS IT

Adenomyosis usually presents as diffuse or focal thickening of the junctional zone on MRI. Myometrial hyperplasia, a feature of adenomyosis, demonstrates low signal intensity compared with the outer myometrium on T₂ weighted images. It manifests as increased junctional zone thickness with unclear margins . Ectopic endometrial glands correspond to high signal intensity foci on T₂ weighted images, some of which are haemorrhagic. Ectopic endometrial glands in adenomyosis are characterized by a predominance of zona basalis and it does not respond to cyclic hormonal stimulation, whereas the zona functionalis does in endometriosis . Therefore haemorrhagic lesions in adenomyosis are usually small and punctate. The cystic form of adenomyosis with extensive glandular cystic changes and haemorrhage is rare . Haemosiderin deposits in the wall of adenomyotic cyst may explain that haemorrhage has occurred several times in the cyst as does in endometriotic cyst. A few MRI reports presented the cases of myometrial and subserosal cystic adenomyosis as prominent high intensity cysts on both T₁ and T₂ weighted images . The cysts were surrounded by low intensity tissue. Our MR findings differed from those of other reports. In our case, abundant solid structure within the mass led to misdiagnoses of ovarian carcinoma associated with endometriotic cyst. The interface between the solid structure and myometrium was diffuse. Signal voids bridging the uterus and tumour were demonstrated and should have suggested a mass of uterine origin. However, we interpreted these findings as invasion of the uterus by an ovarian carcinoma.

The spectrum of epithelial abnormalities including epithelial metaplasia, hyperplasia, atypia, and adenocarcinoma (i.e. endometrioidcarcinoma and clear cell carcinoma) have been described in ovarian endometriotic cysts. A report showed that endometriotic cyst with malignant transformation seldom shows low signal intensity on T₂ weighted images and usually has enhancing mural nodules. The authors speculated that adenocarcinomas in endometriosis may produce some fluid that can dilute dense haemorrhagic material. In contrast, in our case of cystic adenomyosis, the loculi showed variable intensity and the enhancing solid structures were in the hypointense loculus on T₂ weighted images.

There have been few reports of adenocarcinomas arising from adenomyosis. The adenocarcinomas were present in the myometrium without involvement of the eutopic endometrium. Koshimaya et al reported four cases of adenocarcinoma arising form adenomyosis, including a transition from benign adenomyotic to carcinomatous glands. In these cases, MRI and ultrasound did not detect the disease correctly and pre-operative diagnoses were ovarian carcinoma in two cases, adenomyosis in one case, and leiomyoma or leiomyosarcoma in one case. In two cases mimicking ovarian malignancy, tumours showed 7–7.5 cm solid and cystic appearance.

The process of the florid endometrioid glands (endometrial hyperplasia, simple) induced within the cystic adenomyosis remains unclear.The previous use of GnRH analogue might modify the glandular differentiation, since it is known that adenomyosis recurs when hormonal therapy is discontinued. MRI demonstrated this glandular protuberance high signal intensity on T₂ weighted images and marked enhancement. It is interesting that the same has been experienced for simple endometrial hyperplasia of the uterine endometrium .

In conclusion, in our patient with huge subserosal cystic adenomyosis, a confident differentiation of uterine versus ovarian mass, and of benign versus malignant tumour could not be made. Signal voids bridging the uterus and tumour should suggest a diagnosis of a mass of uterine origin. Hyperintense protuberance in the hypointense loculus on T₂ weighted images may be an atypical appearance of malignant ovarian tumour associated with endometriosis. However, surgical exploration and resection is still required to exclude an ovarian malignancy.Pelvic sonography remains the imaging modality of choice for initial evaluation of myometrial pathology. The advent of vaginal sonography and color Doppler sonography have allowed for major refinements in detection and accurate diagnoses of common disorders affecting the uterus, particularly myomas and adenomyosis.

 

Permalink Reply by REGINA RACHAEL on October 4, 2011 at 4:48pm

Thank you for all of this information provided on an extreme topic. I see more women with adenomyosis than fibroids, and many times, the report from Radiologist reads fibroids and not adenomyosis.