PMC3014817_01
Transverse postcontrast CT images (portal phase) reveal numerous uterine leiomyomas of variable size (arrows). The masses show inhomogeneous enhancement after contrast material administration.
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Multiple uterus leiomyomas, of variable size were found, heterogeneously enhancing after contrast material administration (Figure 1).
Sagittal (a) and coronal (b) T2-weighted MR images show uterus enlargement. Multiple, relatively homogeneous fibroids are revealed (arrows), of low signal intensity, causing significant compression of the uterine endometrial cavity (long arrow). (c) Sagittal fat-suppressed T1-weighed image depicts strong and heterogeneous lesion enhancement (arrows).
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An enlarged, posteriorly inclined uterus was found (Figure 2). T2-weighted images, when compared to the outer myometrium (Figure 2(a) and 2(b)), slightly inhomogeneous the larger ones. The masses were well circumscribed, isointense to the adjacent myometrium on T1-weighted images, with contrast enhancement (Figure 2(c)).
Microscopic features of the largest nodule (of 13 cm in diameter). (a) Spindle cells arranged in interlacing bundles, within a collagenous stroma (H+E, x200). (b) The cells have vesicular relatively uniform nuclei (H+E, x400). (c) Leiomyomatous cells express SMA (DAB x200). (d) Leiomyomatous cells express desmin (DAB x200).
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On microscopic examination, all nodules were composed of relatively uniform spindle cells with vesicular nuclei, arranged mostly in interlacing bundles and embedded within a collagenous stroma (Figure 3(a) and 3(b)). Immunohistochemical examination showed cell positivity for smooth muscle actin (SMA, Figure 3(c)) and desmin (Figure 3(d)).
Followup MR imaging study:two years after surgery. Sagittal (a) and coronal (b) T2-weighted images reveal decrease of the uterine size. Multiple leiomyomas of low to intermediate signal intensity (arrows) are detected.
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MR imaging examination performed two years after surgery, when the patient was admitted to the Gynecology clinic with lower abdominal pain, revealed recurrence of fibromatous uterus (Figure 4).