PMC6243359_01
(a) Axial plain CT section with rectal contrast shows lobulated soft tissue attenuation lesion posterior to the uterus (arrow) with a fluid attenuation lesion in the right adnexa (curved arrow). (b) Axial plain CT section with rectal contrast shows lobulated soft tissue attenuation lesions in the sigmoid mesocolon and adjacent to the ascending colon (curved arrows). (c) Axial post-contrast CT section shows lobulated, enhancing soft tissue attenuation lesion in the uterus (curved arrow) with a similar enhancing lesion abutting the sigmoid colon (arrows).
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Abdominal CT scan showed a fundal fibroid involving the anterior wall with a large multilobulated soft tissue density mass posterior to the uterus (Figure 1a). Similar small mass lesions were noted involving the sigmoid mesocolon, left paracolic gutter and adjacent to the ascending colon (Figure 1b). Post-contrast imaging showed homogeneous enhancement of the lesions similar to that of the fundal fibroid (Figure 1c). A right-sided hydrosalphinx was also seen (curved arrow in Figures 1a and 2b).
(a) Axial T2 respiratory triggering (RTr) image of the pelvis shows a lobulated hypointense lesion posterior to the uterus (arrow) with a hyperintense lesion in the right adnexa (curved arrow). (b) Axial T2 RTr image of the pelvis shows a lobulated hypointense lesion adjacent to the caecum (arrows) with a lesion of similar intensity in the uterus (curved arrow).
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MRI showed multiple intramural fibroids exhibiting T1 and T2 weighted hypointensities (Figure 2a). Similar signal intensity extrauterine lesions were noted in the rectouterine pouch, sigmoid mesocolon and left paracolic gutter (Figure 2b). A right-sided hydrosalphinx was also seen (curved arrow in Figures 1a and 2b).
Post-operative specimen shows an enlarged uterus with bosselated surface. Multiple lobulated extrauterine lesions were also removed.
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The patient underwent total abdominal hysterectomy, bilateral salphingo-oophorectomy and removal of peritoneal leiomyomata (Figure 3).
(a) Histopathological section from the intrauterine lesions shows a neoplasm composed of interlacing bundles and whorls of benign spindle cells with focal areas of hyalinization. (b) Histopathological section from an extrauterine lesion shows a whorled pattern of smooth muscle bundles separated from each other by vascularized connective tissue and no pleomorphism.
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Histological examination of the intrauterine lesions showed a tumour composed of interlacing bundles and whorls of benign spindle cells with focal areas of hyalinization (Figure 4a). Multiple extrauterine lesions showed a whorled pattern of smooth muscle bundles separated from each other by vascularized connective tissue and no pleomorphism (Figure 4b).