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GU: Female Pelvis/Endocrine

E3281. Funny Fibroids: Atypical Presentations, Complications, and Variants of a Common Entity

Rosenbaum D1,  Strauss S2,  Gordon S2,  Kobi M2,  Flusberg M.2 1. Albert Einstein College of Medicine, Bronx, NY; 2. Montefiore Medical Center, Bronx, NY

Address correspondence to S. Strauss (

Background Information: Uterine leiomyoma are monoclonal tumors arising from myometrial smooth muscle cells; they are the most common gynecological neoplasm with estimated prevalence of up to 20% in women over the age of 30. Fibroid growth and development is thought to be related to multiple factors, including estrogen/progesterone levels, wound healing/growth factors and genetics. Easily detected on CT, ultrasound and MRI, fibroids are often incidentally reported on studies performed for other purposes. Although commonplace, fibroids and fibroid variants are of diagnostic importance, when atypical in presentation and may present as a diagnostic challenge.

Educational Goals/Teaching Points: The purpose of this electronic exhibit is to highlight atypical presentations of a commonly reported entity, as well as to highlight important imaging features of clinical relevance to the gynecological surgeon and interventional radiologist.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We present a case-based review of atypical presentations of uterine leiomyoma, fibroid-related complications, fibroid variants, relevant imaging descriptors in patients before and after uterine artery embolization and important mimics. Specifically, we discuss unusual leiomyoma growth patterns such as IV leiomyomatosis, benign metastasizing leiomyoma, and parasitic leiomyoma; complications related to fibroids including hydronephrosis secondary to retroperitoneal fibroid, fibroid prolapse, and pedunculated fibroid torsion. Fibroid variants to be reviewed included angioleiomyoma, leiomyosarcoma, and lipoleiomyoma. We review histopathologic and imaging classification of degenerated fibroids as well as imaging features important both before and after uterine artery embolization. We conclude with a discussion of benign and malignant mimics of leiomyoma including focal adenomyoma, uterine contraction, endometrial cancer and ovarian fibroma with imaging pearls that aid in differential diagnosis.

Conclusion: Upon completion of this exhibit, the reader will have reviewed the clinically relevant imaging features, atypical presentations, potential complications and mimickers of this seemingly mundane entity.