PMC3988897_01
Ultrasound: multiple solid masses in the pouch of Douglas (23 mm x 20 mm and 17 mm x 19 mm), with myometrial aspect and central echogenic parts. They are attached to the left ovary and rectosigmoid but without invasion of its muscular wall.
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Gynecological ultrasound (Figure 1) demonstrated not only diffuse uterine adenomyosis and myomas, but also multiple solid masses in the Douglas pouch, attached to the left ovary and rectosigmoid but without invasion of its muscular wall.
Sagittal T2-weighted MR image shows polylobular masses in the pouch of Douglas with very low signal intensity.
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MRI (Figures 2, 3, and 4) and CT (Figure 5) confirmed the presence of solid and strongly hypovascular masses in the pouch of Douglas.
Axial T2-weighted MR image shows polylobular masses in the pouch of Douglas with very low signal intensity.
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MRI (Figures 2, 3, and 4) and CT (Figure 5) confirmed the presence of solid and strongly hypovascular masses in the pouch of Douglas.
On axial fat-suppressed T1-weighted images after gadolinium administration the masses are strongly hypovascular with a peripheral rim-like enhancement.
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MRI (Figures 2, 3, and 4) and CT (Figure 5) confirmed the presence of solid and strongly hypovascular masses in the pouch of Douglas.
Axial CT image after contrast administration shows heterogeneous iso- to hypoattenuating masses in the pouch of Douglas. Inside we can see some punctiform calcifications.
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MRI (Figures 2, 3, and 4) and CT (Figure 5) confirmed the presence of solid and strongly hypovascular masses in the pouch of Douglas.
Several confluent well-circumscribed fibrotic nodules in the pouch of Douglas. Note the intact muscular wall and mucosa of the sigmoid.
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Histologically, there were multiple fibrocollagenous nodules on the omentum, pelvic wall, right ovary, sigmoid, and Douglas pouch (Figure 6).
Histology of a fibrotic nodule (H&E stain, low magnification). It consists of concentric layers of paucicellular hyalinized collagen, with central dystrophic calcification. The surrounding fat tissue contains foci of lymphocytic inflammation.
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These nodules consisted of concentric layers of paucicellular hyalinized collagen, often with central dystrophic calcification (Figures 7 and 8).
Histology of RNFP (H&E stain, high magnification).
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These nodules consisted of concentric layers of paucicellular hyalinized collagen, often with central dystrophic calcification (Figures 7 and 8).