PMC3625880_01
Trans-abdominal ultrasonogram in a 40-year-old woman at the level of urinary bladder shows mixed echogenic, predominantly hyperechoic lesion in pouch of Douglas displacing the uterus (empty arrowhead) anteriorly and cystic (arrow) and solid components (solid arrowhead) within the lesion.
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F1
On ultrasonography, a well-defined, mixed echogenic lesion measuring 22 cm x 12.2 cm x 18.6 cm was seen in the midline posterior to bladder pushing the uterus anterolaterally toward the left side [Figure 1], extending cranially up to mid-abdomen with multiple internal cystic changes [Figure 2].
Longitudinal scan reveals cranial extension of lesion up to umbilicus with multiple internal cystic components (arrows).
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F2
On ultrasonography, a well-defined, mixed echogenic lesion measuring 22 cm x 12.2 cm x 18.6 cm was seen in the midline posterior to bladder pushing the uterus anterolaterally toward the left side [Figure 1], extending cranially up to mid-abdomen with multiple internal cystic changes [Figure 2].
Axial contrast-enhanced computed tomographic scan section at the level of urinary bladder (solid arrowhead) shows displacement of uterus anterolaterally (arrow) and mixed density mass posteriorly (empty arrowhead).
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F3
On contrast-enhanced computed tomographic (CECT) scan of abdomen and pelvis, a large mixed density abdomino-pelvic lesion was seen in the pouch of Douglas with thick internal septations and solid components [Figure 3].
Axial contrast-enhanced computed tomographic scan at a higher level reveals thick enhancing septae (arrowheads) and cystic components (arrow).
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F4
The septations and solid components showed significant enhancement on postcontrast images [Figure 4].
Gross surgically removed specimen of giant fibroid in the right broad ligament with normal ovaries (arrows) and uterus (arrow head).
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F5
The surgically resected specimen included a large nodular cystic mass measuring 25 cm x 25 cm x 8 cm adjacent to the uterus in the right broad ligament with bilateral normal ovaries [Figure 5].
Microscopic examination of the surgically removed specimen found in the right broad ligament demonstrates interlacing bundles of smooth muscle cells (arrow), scattered thick walled blood vessels, and evidence of cystic, myxoid, and hyaline degeneration (arrowhead) (Hematoxylin and eosin, x100)..
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F6
Section studied from the larger parametrial mass showed a benign tumor with interlacing bundles of smooth muscle cells, scattered thick-walled blood vessels, and evidence of cystic, myxoid and hyaline degeneration [Figure 6].