Dr. Paul MacKoul MD: Learn About Adenomyosis and Minimally Invasive Adenomyosis Surgery at CIGC
Fibroids&adenomyosis
Transcript of Fibroids&adenomyosis
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Fibroids and Adenomyosis
Dr.Aftab Qadir
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1.Uterine leiomyoma
Benign tumours of myometrium
Most common solid benign uterine
neoplasm
~25% of women of reproductive age
Responsive to hormones
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Often asymptomatic
Menorrhagia
Pain
Infertility
Palpable mass
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Radiographic features
Conventional radiography
Popcorn calcification or peripheral rim of calcification
Displacement of bowel gas by a pelvic mass
Ultrasound
Usually hypoechoic, but can be isoechoic, or even hyperechoic
Calcification
Cystic areas of necrosis or degeneration
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CT
Usually of soft tissue density
May exhibit coarse peripheral or
central calcification
May distort the usually smooth uterine
contour
Enhancement pattern is variable
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Pelvic MRI
Low to intermediate signal intensity
on T1 and T2 weighted images
compared with the normal
myometrium
High central signal intensity on T2
from hemorrhage
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Complications
Malignant degeneration
into leiomyosarcomas
May torse, leading to acute pelvic pain
Pregnancy may cause fibroid growth
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Differential diagnosis
Uterine leiomyosarcoma
Uterine lipoleiomyoma
Ovarian masses
Focal myometrial contraction during
pregnancy
Focal adenomyosis
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2.Adenomyosis
Ectopic endometrial tissue in the
myometrium
Spectrum of endometriosis
Women of reproductive age
Higher frequency history of surgical
uterine procedures
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Symptomatic:
Menorrhagia and dysmenorrhea
May present with chronic pelvic pain
In 20% of cases is associated with co-
existent endometriosis
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Types
Diffuse adenomyosis: most common
Focal adenomyosis
Cystic adenomyosis: rare
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Ultrasound
Sonographic features are variable.
Normal appearing uterus
Focal or diffuse myometrial bulkiness, typically of the posterior wall
Thickening of the transition zone
Subendometrial echogenic linear striations
Subendometrial echogenic nodules
Small myometrial cysts / sub endometrial cysts
Heterogeneous myometrial echotexture
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Hysterosalpingogram (HSG)
May show diverticula extending into
the myometrium
CT
May suggest its presence when
uterine enlargement is present.
Distinguishing between adenomyosis
and uterine fibroids is difficult
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Pelvic MRI
Modality of choice to diagnose
and characterise adenomyosis
T2 weighted images are most useful
Thickening of the junctional zone of
the uterus to more than 12 mm
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T2
◦ Appears as an ill-defined focal/diffuse
region of thickening, often with small high
T2 signal regions representing small
regions of cystic change
T1
◦ Foci of high T1 signal are often seen
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Differences on sonography
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Few cases
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Thank You