Presentation
Distended abdomen.
Patient Data
Large well-circumscribed uterine mass of intramural location. It demonstrates a low signal on T1, high signal on T2 centrally and isosignal to the myometrium on T1 and T2 peripherally. The postcontrast sequences demonstrate a heterogeneous enhancement of the peripheral solid component as well as the septa of the central cystic component.
Another small subserosal leiomyoma is noted.
No pelvic ascites or enlarged lymph nodes.
Case Discussion
MRI features most consistent with a large intramural leiomyoma with central cystic degeneration.
When the leiomyoma increases in size, the vascular supply to it becomes inadequate and leads to different types of degeneration: hyaline, cystic, myxoid, or red degeneration. Hyalinization is the commonest type of degeneration. Cystic degeneration is an uncommon type and represents ~4% of all types of uterine leiomyoma degeneration.
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