PMC5303581_01
CT angiography. Axial section through right hypochondrium showed a well-defined oval shaped enhancing mass lesion along the peritoneal surface (a); axial section through the lower abdomen revealed few round well-defined homogenously enhancing soft tissue lesions in the mesentery (red circle in (b) and (c)) and yellow arrow shows a postsurgical changes in the uterus (b); volume rendering image of the right hypochondrium (d) shows the blood supply from right 10th intercoastal artery (thin arrow) and from the branch of right internal mammary artery (curved arrow). Thick arrow represents the mass lesion.
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In addition, multiple well-defined round to oval homogenously enhancing lesions were also noted in the mesentery in the left iliac fossa and along the superior border of urinary bladder (Figure 1).
MRI of lower abdomen. Axial (a), coronal (b), and sagittal (c) sections of T2WI through the lower abdomen revealed a large heterogeneous pelvic-abdominal mass lesion in relation to the uterus. The mass appears to be inseparable from the adjacent mesentery and omentum. A tortuous vascular pedicle is also seen in the coronal section (b). Axial section of SWI sequence through the mass lesion showed areas of blooming suggestive of intralesional hemorrhagic foci (d). The mass lesion shows extensive enhancement after administration of gadolinium contrast (e).
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MRI (Figure 2) and CT angiography (Figure 3) were performed to localize the origin and relation with adjacent structure and visualize and locate the feeding vessels and to facilitate embolization better, respectively.
CT Angiography. Axial scan through the lower abdomen revealed a large heterogenous mass with multiple intralesional vascular channels ((a) and (b)); volume rendering reconstructed images ((c) and (d)) show a hypertrophied vascular channel (omental branch) arising from the right gastroepiploic artery (red arrow on (c)) which is encircled with a draining tributary which is drained into the superior mesenteric vein (yellow arrow on (d)); an angiographic reconstructed image (e) shows a highly vascular mass with multiple intralesional vascular channels (red circle).
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MRI (Figure 2) and CT angiography (Figure 3) were performed to localize the origin and relation with adjacent structure and visualize and locate the feeding vessels and to facilitate embolization better, respectively.
Conventional angiography of right gastroepiploic artery. The omental branch of right gastroepiploic artery was embolized using coils at its distal most end ((a) and (b)) and at proximal end ((c) and (d)). Postembolization images ((b) and (d)) showed complete embolization of this artery.
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This feeding artery was superselectively catheterized using Progreat microcatheter and embolized using coils just proximal to the fibroid and at the origin from the gastroepiploic artery (Figure 4).
Histopathological analysis. Microscopic images of pelvic-abdominal mass (a) show intertwining bundles of smooth muscle cells and microscopic images omentum (b) show multiple irregular but discrete smooth muscle proliferation (leiomyomatous proliferation).
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Histopathological analysis (Figure 5) confirmed the diagnosis of fibroid with tongue like extension of smooth muscle into the subserosal fat of colonic wall and proliferation of smooth muscles into the omentum suggestive of disseminated fibroid.