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Uterine leiomyomas revisited with review of literature

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Abstract

Uterine leiomyomas, more commonly known as fibroids, are the most common neoplasms of the uterus. These tumors have a profound effect on health care and cost worldwide. Depending on the race, uterine leiomyomas can be seen in 70–80% of all women. Although majority of the women with uterine leiomyomas remain asymptomatic, approximately 30% can present with symptoms. Diagnosing typical leiomyomas on imaging is straightforward. However, when large, located extrauterine and especially with degeneration, the diagnosis can be challenging on imaging. In this article, apart from reviewing the demographics and management of patients with leiomyomas, we describe in detail the imaging appearance of various atypical leiomyomas, uncommon locations outside the uterus and their important differential diagnosis that can have a profound effect on patient management.

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References

  1. Whiteman MK, Kuklina E, Jamieson DJ, Hillis SD, Marchbanks PA. Inpatient hospitalization for gynecologic disorders in the United States. Am J Obstet Gynecol. 2010 Jun;202(6):541.e1-6.

    Article  Google Scholar 

  2. Merrill RM. Hysterectomy surveillance in the United States, 1997 through 2005. Med Sci Monit. 2008 Jan;14(1):CR24–31. PMID: 18160941.

  3. Jones HW, Jones GS, eds. Gynecology, 3rd ed. Baltimore: Williams & Wilkins; 1982;245–253.

  4. Pavone D, Clemenza S, Sorbi F, Fambrini M, Petraglia F. Epidemiology and Risk Factors of Uterine Fibroids. Best Pract Res Clin Obstet Gynaecol. 2018 Jan;46:3-11.

    Article  PubMed  Google Scholar 

  5. Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011 Apr;113(1):3–13. https://doi.org/10.1016/j.ijgo.2010.11.011. Epub 2011 Feb 22. PMID: 21345435.

  6. Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Primers. 2016 Jun 23;2:16043.

    Article  Google Scholar 

  7. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003 Jan;188(1):100-7. https://doi.org/10.1067/mob.2003.99. PMID: 12548202.

    Article  PubMed  Google Scholar 

  8. Drayer SM, Catherino WH. Prevalence, morbidity, and current medical management of uterine leiomyomas. Int J Gynaecol Obstet. 2015 Nov;131(2):117-22.

    Article  PubMed  Google Scholar 

  9. Bartels CB, Cayton KC, Chuong FS, Holthouser K, Arian SE, Abraham T, Segars JH. An Evidence-based Approach to the Medical Management of Fibroids: A Systematic Review. Clin Obstet Gynecol. 2016 Mar;59(1):30-52.

    Article  PubMed  Google Scholar 

  10. Bukulmez O, Doody KJ. Clinical features of myomas. Obstet Gynecol Clin North Am. 2006 Mar;33(1):69-84. https://doi.org/10.1016/j.ogc.2005.12.002. PMID: 16504807.

    Article  PubMed  Google Scholar 

  11. Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016 Nov;22(6):665-686.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Levy G, Hill MJ, Beall S, Zarek SM, Segars JH, Catherino WH. Leiomyoma: genetics, assisted reproduction, pregnancy and therapeutic advances. J Assist Reprod Genet. 2012 Aug;29(8):703-12.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Murase E, Siegelman ES, Outwater EK, Perez-Jaffe LA, Tureck RW. Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics. 1999 Sep-Oct;19(5):1179–97.

  14. Panageas E, Kier R, McCauley TR, McCarthy S. Submucosal uterine leiomyomas: diagnosis of prolapse into the cervix and vagina based on MR imaging. AJR Am J Roentgenol. 1992 Sep;159(3):555-8.

    Article  CAS  PubMed  Google Scholar 

  15. Karasick S, Lev-Toaff AS, Toaff ME. Imaging of uterine leiomyomas. AJR Am J Roentgenol. 1992 Apr;158(4):799-805.

    Article  CAS  PubMed  Google Scholar 

  16. Casillas J, Joseph RC, Guerra JJ Jr. CT appearance of uterine leiomyomas. Radiographics. 1990 Nov;10(6):999-1007. https://doi.org/10.1148/radiographics.10.6.2259770.

    Article  CAS  PubMed  Google Scholar 

  17. Lakhani A, Khan SR, Bharwani N, Stewart V, Rockall AG, Khan S, Barwick TD. FDG PET/CT Pitfalls in Gynecologic and Genitourinary Oncologic Imaging. Radiographics. 2017 Mar-Apr;37(2):577–594.

  18. Nunes RF, Queiroz MA, Buchpiguel CA, Carvalho FM, Carvalho JP. Aberrant Hypermetabolism of Benign Uterine Leiomyoma on 18F-FDG PET/CT. Clin Nucl Med. 2019 Jun;44(6):e413-e414.

    Article  PubMed  Google Scholar 

  19. Kitajima K, Murakami K, Kaji Y, Sugimura K. Spectrum of FDG PET/CT findings of uterine tumors. AJR Am J Roentgenol. 2010 Sep;195(3):737-43.

    Article  PubMed  Google Scholar 

  20. Woźniak A, Woźniak S. Ultrasonography of uterine leiomyomas. Prz Menopauzalny. 2017;16(4):113-117. doi:https://doi.org/10.5114/pm.2017.72754

    Article  PubMed  PubMed Central  Google Scholar 

  21. Early HM, McGahan JP, Scoutt LM, Revzin M, Lamba R, Corwin M, Fananapazir G, Sekhon S. Pitfalls of Sonographic Imaging of Uterine Leiomyoma. Ultrasound Q. 2016 Jun;32(2):164-74.

    Article  PubMed  Google Scholar 

  22. Takeuchi M, Matsuzaki K, Nishitani H. Manifestations of the female reproductive organs on MR images: changes induced by various physiologic states. Radiographics. 2010 Jul-Aug;30(4):1147.

  23. Hricak H, Tscholakoff D, Heinrichs L, Fisher MR, Dooms GC, Reinhold C, Jaffe RB. Uterine leiomyomas: correlation of MR, histopathologic findings, and symptoms. Radiology. 1986 Feb;158(2):385-91.

    Article  CAS  PubMed  Google Scholar 

  24. Dudiak CM, Turner DA, Patel SK, Archie JT, Silver B, Norusis M. Uterine leiomyomas in the infertile patient: preoperative localization with MR imaging versus US and hysterosalpingography. Radiology. 1988 Jun;167(3):627-30.

    Article  CAS  PubMed  Google Scholar 

  25. Tanaka YO, Nishida M, Tsunoda H, Okamoto Y, Yoshikawa H. Smooth muscle tumors of uncertain malignant potential and leiomyosarcomas of the uterus: MR findings. J Magn Reson Imaging. 2004 Dec;20(6):998-1007.

    Article  PubMed  Google Scholar 

  26. Ha HK, Jee MK, Lee HJ, Choe BY, Park JS, Lee JM, Nam-Koong SE. MR imaging analysis of heterogeneous leiomyomas of the uterus. Front Biosci. 1997 Apr 1;2:f4-12.

    Article  Google Scholar 

  27. Bolan C, Caserta MP. MR imaging of atypical fibroids. Abdom Radiol (NY). 2016 Dec;41(12):2332-2349.

    Article  PubMed  Google Scholar 

  28. Okizuka H, Sugimura K, Takemori M, Obayashi C, Kitao M, Ishida T. MR detection of degenerating uterine leiomyomas. J Comput Assist Tomogr. 1993 Sep-Oct;17(5):760–6.

  29. Wilde S, Scott-Barrett S. Radiological appearances of uterine fibroids. Indian J Radiol Imaging. 2009;19(3):222-231. doi:https://doi.org/10.4103/0971-3026.54887

    Article  PubMed  Google Scholar 

  30. Takeuchi M, Matsuzaki K, Bando Y, Harada M. Evaluation of Red Degeneration of Uterine Leiomyoma with Susceptibility-weighted MR Imaging. Magn Reson Med Sci. 2019 Apr 10;18(2):158-162.

    Article  PubMed  Google Scholar 

  31. Nakai G, Yamada T, Hamada T, et al. Pathological findings of uterine tumors preoperatively diagnosed as red degeneration of leiomyoma by MRI. Abdom Radiol (NY). 2017;42(7):1825-1831. doi:https://doi.org/10.1007/s00261-017-1126-3

    Article  PubMed  PubMed Central  Google Scholar 

  32. Naz S, Rehman A, Riyaz A, Jehangir F, Naeem S, Iqbal T. Leiomyoma: Its Variants And Secondary Changes A Five-Year Study. J Ayub Med Coll Abbottabad. 2019 Apr-Jun;31(2):192–195.

  33. Yamashita Y, Torashima M, Takahashi M, Tanaka N, Katabuchi H, Miyazaki K, Ito M, Okamura H. Hyperintense uterine leiomyoma at T2-weighted MR imaging: differentiation with dynamic enhanced MR imaging and clinical implications. Radiology. 1993 Dec;189(3):721-5.

    Article  CAS  PubMed  Google Scholar 

  34. Gadducci A, Zannoni GF. Uterine smooth muscle tumors of unknown malignant potential: A challenging question. Gynecol Oncol. 2019 Sep;154(3):631-637.

    Article  PubMed  Google Scholar 

  35. Arleo EK, Schwartz PE, Hui P, McCarthy S. Review of Leiomyoma Variants. AJR Am J Roentgenol. 2015 Oct;205(4):912-21.

    Article  PubMed  Google Scholar 

  36. Batur A, Alpaslan M, Dundar I, Ozgokce M, Yavuz A. Uterin Lipoleiomyoma: MR Findings. Pol J Radiol. 2015 Sep 17;80:433-4.

    Article  Google Scholar 

  37. Konishi I. Diffuse Leiomyomatosis: Complete Myomectomy for Innumerable Small Nodules to Achieve Fertility Sparing and Childbearing. Surg J (N Y). 2019 Aug 29;6(Suppl 1):S50-S57.

    Google Scholar 

  38. Koh J, Kim MD, Jung DC, Lee M, Lee MS, Won JY, Lee DY, Park SI, Lee KH. Uterine artery embolization (UAE) for diffuse leiomyomatosis of the uterus: clinical and imaging results. Eur J Radiol. 2012 Oct;81(10):2726-9.

    Article  PubMed  Google Scholar 

  39. Deshmukh SP, Gonsalves CF, Guglielmo FF, Mitchell DG. Role of MR imaging of uterine leiomyomas before and after embolization. Radiographics. 2012 Oct;32(6):E251-81.

    Article  PubMed  Google Scholar 

  40. El-Agwany AS. Huge Broad Ligament Fibroid with Paracervical Extension: A Safe Approach by Same Setting Myomectomy before Hysterectomy. J Med Ultrasound. 2018;26(1):45-47.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Jha S, Singh A, Singh S, Murmu S. Huge broad ligament leiomyoma with cystic degeneration: A diagnostic and surgical challenge. J Obstet Gynaecol Res. 2020 May;46(5):791-794.

    Article  PubMed  Google Scholar 

  42. Low HY, Zhao Y, Huang KS, Shen HP, Wu PJ, Tseng CJ. Intravenous leiomyomatosis of the uterus: A clinicopathological analysis of nine cases and literature review. Taiwan J Obstet Gynecol. 2017 Jun;56(3):362-365.

    Article  PubMed  Google Scholar 

  43. Wang H, Nie P, Chen B, Hou F, Dong C, He F, Xu W. Contrast-enhanced CT findings of intravenous leiomyomatosis. Clin Radiol. 2018 May;73(5):503.e1-503.e6.

    Article  CAS  Google Scholar 

  44. Julien C, Bourgouin S, Boudin L, Balandraud P. Disseminated Peritoneal Leiomyomatosis. J Gastrointest Surg. 2019 Mar;23(3):605-607.

    Article  PubMed  Google Scholar 

  45. Fasih N, Prasad Shanbhogue AK, Macdonald DB, Fraser-Hill MA, Papadatos D, Kielar AZ, Doherty GP, Walsh C, McInnes M, Atri M. Leiomyomas beyond the uterus: unusual locations, rare manifestations. Radiographics. 2008 Nov-Dec;28(7):1931–48.

  46. Jolissaint JS, Kilbourne SK, LaFortune K, Patel M, Lau CL. Benign metastasizing leiomyomatosis (BML): A rare cause of cavitary and cystic pulmonary nodules. Respir Med Case Rep. 2015;16:122–124. Published 2015 Sep 21.

  47. Lete I, González J, Ugarte L, Barbadillo N, Lapuente O, Álvarez-Sala J. Parasitic leiomyomas: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2016 Aug;203:250-9.

    Article  PubMed  Google Scholar 

  48. Toro JR, Travis LB, Wu HJ, Zhu K, Fletcher CD, Devesa SS. Incidence patterns of soft tissue sarcomas, regardless of primary site, in the surveillance, epidemiology and end results program, 1978-2001: An analysis of 26,758 cases. Int J Cancer. 2006 Dec 15;119(12):2922-30.

    Article  CAS  PubMed  Google Scholar 

  49. Wu CQ, Woo LY, Giede KC, Thiel J, Karreman E, Rattray DD. Occult Leiomyosarcomas in a Canadian Province: A Retrospective Cohort Study. J Obstet Gynaecol Can. 2019 Jan;41(1):46-51.

    Article  PubMed  Google Scholar 

  50. Sun S, Bonaffini PA, Nougaret S, Fournier L, Dohan A, Chong J, Smith J, Addley H, Reinhold C. How to differentiate uterine leiomyosarcoma from leiomyoma with imaging. Diagn Interv Imaging. 2019 Oct;100(10):619-634.

    Article  CAS  PubMed  Google Scholar 

  51. Lin G, Yang LY, Huang YT, Ng KK, Ng SH, Ueng SH, Chao A, Yen TC, Chang TC, Lai CH. Comparison of the diagnostic accuracy of contrast-enhanced MRI and diffusion-weighted MRI in the differentiation between uterine leiomyosarcoma / smooth muscle tumor with uncertain malignant potential and benign leiomyoma. J Magn Reson Imaging. 2016 Feb;43(2):333-42.

    Article  PubMed  Google Scholar 

  52. Namimoto T, Yamashita Y, Awai K, Nakaura T, Yanaga Y, Hirai T, Saito T, Katabuchi H. Combined use of T2-weighted and diffusion-weighted 3-T MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol. 2009 Nov;19(11):2756-64.

    Article  PubMed  Google Scholar 

  53. Abdel Wahab C, Jannot AS, Bonaffini PA, Bourillon C, Cornou C, Lefrère-Belda MA, Bats AS, Thomassin-Naggara I, Bellucci A, Reinhold C, Fournier LS. Diagnostic Algorithm to Differentiate Benign Atypical Leiomyomas from Malignant Uterine Sarcomas with Diffusion-weighted MRI. Radiology. 2020 Nov;297(2):361-371.

    Article  PubMed  Google Scholar 

  54. Rahimifar P, Hashemi H, Malek M, Ebrahimi S, Tabibian E, Alidoosti A, Mousavi A, Yarandi F. Diagnostic value of 3 T MR spectroscopy, diffusion-weighted MRI, and apparent diffusion coefficient value for distinguishing benign from malignant myometrial tumours. Clin Radiol. 2019 Jul;74(7):571.e9-571.e18.

    Article  CAS  Google Scholar 

  55. Cunningham RK, Horrow MM, Smith RJ, Springer J. Adenomyosis: A Sonographic Diagnosis. Radiographics. 2018 Sep-Oct;38(5):1576–1589.

  56. Agostinho L, Cruz R, Osório F, Alves J, Setúbal A, Guerra A. MRI for adenomyosis: a pictorial review. Insights Imaging. 2017;8(6):549-556.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Sadro CT. Imaging the Endometrium: A Pictorial Essay. Can Assoc Radiol J. 2016 Aug;67(3):254-62.

    Article  PubMed  Google Scholar 

  58. Grasel RP, Outwater EK, Siegelman ES, Capuzzi D, Parker L, Hussain SM. Endometrial polyps: MR imaging features and distinction from endometrial carcinoma. Radiology. 2000 Jan;214(1):47-52.

    Article  CAS  PubMed  Google Scholar 

  59. Lee Y, Kim KA, Song MJ, Park YS, Lee J, Choi JW, Lee CH. Multiparametric magnetic resonance imaging of endometrial polypoid lesions. Abdom Radiol (NY). 2020 Nov;45(11):3869-3881. https://doi.org/10.1007/s00261-020-02567-7.

    Article  PubMed  Google Scholar 

  60. Karakas O, Karakas E, Dogan F, Kilicaslan N, Camuzcuoglu A, Incebiyik A, Camuzcuoglu H. Diffusion-weighted MRI in the differential diagnosis of uterine endometrial cavity tumors. Wien Klin Wochenschr. 2015 Apr;127(7-8):266-73.

    Article  PubMed  Google Scholar 

  61. Meissnitzer M, Forstner R. MRI of endometrium cancer - how we do it. Cancer Imaging. 2016 May 9;16:11.

    Article  Google Scholar 

  62. De La Cruz MS, Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017 Jan 15;95(2):100-107.

    Google Scholar 

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RPM designed and wrote the manuscript; SF wrote the manuscript; VJ collected images and literature; SA supervised the project.

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Correspondence to Rishi Philip Mathew.

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Mathew, R.P., Francis, S., Jayaram, V. et al. Uterine leiomyomas revisited with review of literature. Abdom Radiol 46, 4908–4926 (2021). https://doi.org/10.1007/s00261-021-03126-4

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