Exophytic Lipoleiomyoma of the Uterus Mimicking Ovarian Teratoma: A Case Report

Lipoleiomyoma is a rare benign neoplasm of the uterus. I present here a case of exophytic uterine lipoleiomyoma in a 77-year-old woman. Due to its exophytic nature, this fatty tumor mimicked ovarian teratoma on the imaging studies.

Exophytic Lipoleiomyoma of the Uterus Mimicking Ovarian Teratoma: A Case Report

Lipoleiomyoma is a rare benign neoplasm of the uterus. I present here a case of exophytic uterine lipoleiomyoma in a 77-year-old woman. Due to its exophytic nature, this fatty tumor mimicked ovarian teratoma on the imaging studies.

CT and MR Imaging Findings of Endometrial Stromal Sarcomas

PURPOSE: To evaluate the imaging findings of endometrial stromal sarcoma (ESS) according to histopathologic grade. MATERIALS AND METHODS: Six patients with pathologically proven ESS were included in this study. The histopathologic diagnosis was low-grade ESS for three patients and high-grade ESS for the three others. Preoperative CT or MR images were evaluated in terms of tumor size, location, growth pattern, the presence of hemorrhage or necrosis, status of the endometrial cavity, and invasion of surrounding structures. The imaging features of ESSs, which varied according to their histopathologic grade, were compared. RESULTS: The mean maximal diameter of low-and high-grade ESSs was 6 cm and 11.2 cm, respectively. All three low-grade ESSs were located mainly in the myometrium, but two high-grade ESSs were situated in the endometrial cavity and associated with focal tumor extension into the myometrium. One high-grade ESS had completely replaced the uterus. Low-grade ESSs were relatively well-defined, but high-grade ESSs had an irregular and lobulated margin. Intratumoral hemorrhage and necrosis were, respectively, found in two and three high-grade ESSs. Widening of the endometrial cavity was noted in all three high-grade ESSs, and lymph node metastasis had occurred in one. CONCLUSION: The imaging findings of ESS vary from a well-defined intramural mass to a bulky infiltrating mass, and depend on their histopathologic grade.

Hemoptysis and Hemoperitoneum due to Metastatic Gestational Choriocarcinma: Bronchial Artery Embolization and Superselective Splenic Artery Embolization: A Case Report

Gestational choriocarcinoma is easily disseminated hematogenously and its hypervascular nature places the patient at risk of significant hemorrhage both at the sites of metastatic lesions and in the uterus. In addition, its tends to give rise to pseudoaneurysm formation. Treatment of the condition by percutaneous embolization has been reported in several published articles, and hemoperitoneum secondary to rupture of splenic metastasis of gestational choriocarcinoma has also been reported, as has angiographic embolization. Hemoptysis resulting from pulmonary metastasis and treatment by means of embolization of the bronchial artery have not been reported, however. In this article, we describe a case of hemoptysis and hemoperitoneum due to pulmonary and splenic metastasis of gestational choriocarcinoma. Treatment of the condition involved embolization of the bronchial artery and superselective embolization of the splenic artery.

Diagnosis of Recurrent Uterine Cervical Cancer: Computed Tomography versus Positron Emission Tomography

OBJECTIVE: To determine the accuracy of CT and positron emission tomography (PET) in the diagnosis of recurrent uterine cervical cancer. MATERIALS AND METHODS: Imaging findings of CT and PET in 36 patients (mean age, 53 years) in whom recurrent uterine cervical cancer was suspected were analyzed retrospectively. Between October 1997 and May 1998, they had undergone surgery and/or radiation therapy. Tumor recurrence was confirmed by pathologic examination or follow-up studies. RESULTS: In detecting recurrent uterine cervical cancer, the sensitivity, specificity, and accuracy of CT were 77.8%, 83.3%, and 80.5%, respectively, while for PET, the corresponding figures were 100%, 94.4%, and 97.2%. The Chisquare test revealed no significant difference in specificity (p = .2888), but significant differences in sensitivity (p = .0339) and accuracy (p = .0244). CONCLUSION: PET proved to be a reliable screening method for detecting recurrent uterine cervical cancer, but to determine the anatomical localization of recurrent tumors, and thus decide an adequate treatment plan, CT was eventually needed.

Recurrent Uterine Cervical Carcinoma:Spectrum of Imaging Findings

Uterine cervical carcinoma is one of the most common malignant tumors occur-ring in females. After primary treatment, patients are usually followed up with CT or MRI and the findings of these modalities may be the first sign of recurrent disease. Because earlier additional treatment by chemotherapy or radiation therapy may improve the prognosis, the early detection of recurrent cervical carcinoma is clinically important. In this article, we review the CT and MR imaging findings of recurrent uterine cervical carcinoma, and assign them to one of four groups: a)recurrence at the primary site, involving the intrapelvic organs, b) extension to the pelvic side-wall, c) metastases to pelvic and extrapelvic lymph nodes, or d)metastases to distant organs. A further contribution of CT and MR imaging is the detection of hydronephrosis due to ureteral obstruction. The cases in each group are illustrated and discussed, and since an awareness of the spectrum of imaging findings of recurrent cervical carcinoma is likely to lead to its early detection, radi-ologists should be familiar with the information presented.

Uterine Arterial Embolization for Uterine Leiomyoma: Efficacy and Clinical Outcome

PURPOSE: To determine the efficacy and clinical outcome of uterine arterial embolization as a new approach to the management of uterine leiomyomas MATERIALS AND METHODS: Uterine arterial embolization was performed in 21 patients aged 26-62(mean, 42) years. Twenty of these had menorrhagia, dysmenorrhea, and mass-related symptoms (low abdorminal discomfort, backache, urinary frequency, etc.) and one was diagnesed incidentally. Bilateral uterine arteries were selected individually and polyvinyl alcohol and/or gelfoam was used as an embolic material. RESULTS: Nineteen patients were followed up after embolization. Seventeen (89.5 %) reported satisfactory myoma volume. In 17 patients (89.5 %), the menstrual cycle returned to normal. All patients experienced pain after the procedure and other complications were vaginal bleeding (26.3%) and fever (23.8%). CONCLUSION: Uterine arterial embolization represents a new approach to the management of uterine leiomyoma-related symptoms. Further investigations and long-term follow-up are, however, equired.

CT and MRI Findings of Metastatic Uterine Carcinoma from Gastric Cancer: A Case Report

Uterine metastasis from stomach carcinoma occurred in a patient who five years previously had undergonegastrectomy for gastric adenocarcinoma. CT scans showed an ill-defined lobulated low density mass in the center ofthe uterus. T1-weighted MRI imaging showed that the lesion was indistinct from the myometrium; on T2-weightedimaging it showed increased signal intensity and had infiltrated the myometrium. After Gd-DTPA administration, thelesion showed very little enhancement.

Usefulness of Spiral CT in Parametrial Invasion of Cervical Carcinoma

PURPOSE: To evaluate the efficacy of the arterial phase of spiral CT in parametrial invasion of uterine cervical carcinoma. MATERIALS AND METHODS: Two-phase spiral CT images of 22 patients with pathologically proven cervical carcinomas were retrospectively, studied. With regard to the lateral margin of the cervix, eccentric parametrial soft tissue, Parametrial strands and obliteration of periureteral fat, images of the arterial phase were compared by three radiologists with those of the late phase. RESULTS: Five of 15 surgically-proven cervical cancers with no parametrial involvement (33%) showed parametrial strands or eccentric soft tissue lesion in the late phase. Four of the five patients (80%) showed early vascular enhancement of the linear strands or eccentric soft tissue mass in the arterial, phase and because of this additional scan, correct diagnosis was possible. Six of seven cases of invasive cervical cancer (85.7%) showed linear strands in the late phase but two patients showed partial vascular enhancement of the parametrial strands and correct diagnosis was therefore possible. For the evaluation of the lateral margin of the cervix (4/7, 57.1%) and periureteral fat obliteration (3/7, 42.9%), images of the late phase were superior to those of the arterial phase. CONCLUSION: In uterine cervical carcinoma, the late phase of conventional CT is normally used to identify vascular structures as false-positive parametrial strands ; the arterial phase of spiral CT is, however, superior.

CT and MRI Findings of Malignant Mixed Mullerian Tumor of the Uterus: Irradiation-associated vs Non-associated

PURPOSE: The purpose of this study is to present imaging findings of MMMT developed after irradiation and to compare them with those not associated with irradiation. MATERIALS AND METHODS: Patients with pathologically-proven MMMT were divided into two groups ; group 1, with a history of pelvic irradiation (n=9), and group 2, without such history(n=4). With regard to tumor location, size, extent, degree of myometrial invasion, presence of enhancement, and internal texture of a tumor, we analyzed CT(n=10) and MR imaging (n=8) findings in each group. RESULTS: The tumor was larger in group 1 (average 8.7 cm) than in group 2 (average 5.5 cm). In eight patients in group 1, the endometrial cavity was distended, with remarkable fluid retention, and a mass was found in the fundus or body. The junctional zone was disrupted and hemorrhagic or necrotic foci were found within the mass. In all patients in group 2 and in one in group 1, a tumor had replaced the endometrial cavity, without fluid retention. CONCLUSION: Imaging findings of irradiation-associated MMMT appeared to be different from those not associated with irradiation. Where there are findings of a distended endometrial cavity filled with fluid andmural mass, one should be alert to the possibility of irradiation-associated MMMT.

CT and MRI Findings of Malignant Mixed Mullerian Tumor of the Uterus: Irradiation-associated vs Non-associated

PURPOSE: The purpose of this study is to present imaging findings of MMMT developed after irradiation and to compare them with those not associated with irradiation. MATERIALS AND METHODS: Patients with pathologically-proven MMMT were divided into two groups ; group 1, with a history of pelvic irradiation (n=9), and group 2, without such history(n=4). With regard to tumor location, size, extent, degree of myometrial invasion, presence of enhancement, and internal texture of a tumor, we analyzed CT(n=10) and MR imaging (n=8) findings in each group. RESULTS: The tumor was larger in group 1 (average 8.7 cm) than in group 2 (average 5.5 cm). In eight patients in group 1, the endometrial cavity was distended, with remarkable fluid retention, and a mass was found in the fundus or body. The junctional zone was disrupted and hemorrhagic or necrotic foci were found within the mass. In all patients in group 2 and in one in group 1, a tumor had replaced the endometrial cavity, without fluid retention. CONCLUSION: Imaging findings of irradiation-associated MMMT appeared to be different from those not associated with irradiation. Where there are findings of a distended endometrial cavity filled with fluid andmural mass, one should be alert to the possibility of irradiation-associated MMMT.