ARRS 2022 Abstracts

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E1403. Pictorial Review of Fibroids: Typical and Atypical Presentations, FIGO Classification, and Complications
Authors
  1. Sameer Sandhu; Emory University School of Medicine
  2. Hardik Uresh Shah; Emory University School of Medicine
  3. Jamil Shaikh; Emory University School of Medicine
  4. Gail Peters; Emory University School of Medicine
Background
Uterine fibroids are benign tumors of myometrial origin with varying amounts of fibrous connective tissue and are the most common benign solid uterine neoplasms. They have been reported to occur in up to 70% of women by age 50 and are more common in Black females. Although majority of females with fibroids are asymptomatic, many present with symptoms including but not limited to menorrhagia, pelvic pain, and infertility. Hysterectomy and myomectomy have been the traditional surgical treatments for symptomatic fibroids, and uterine fibroid embolization has been an effective minimally invasive treatment option.

Educational Goals / Teaching Points
This exhibit aims to illustrate the imaging features of typical and atypical fibroids on US and MRI; illustrate the FIGO classification system of fibroid anatomy; illustrate the complications of leiomyomas; illustrate the common differential diagnosis; discuss utility of MRI in pre-treatment planning and post-treatment follow-up; and review of treatment complications after uterine artery embolization.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit includes the following: 1) normal anatomy uterus (US and MRI); 2) typical leiomyoma ((non-degenerated) imaging findings on US and MRI (location: submucosal, intramural, subserosal; FIGO classification); 3) atypical/degenerated leiomyoma (cystic; hemorrhagic/red; hyaline; myxoid); 4) differential diagnosis (uterine leiomyosarcoma; focal adenomyosis; ovarian or adnexal mass); 5) complications (torsion of subserosal pedunculated fibroid; urinary obstruction; parasitic fibroid; sarcomatous degeneration); role of MRI in pre-treatment planning and post-treatment follow up after uterine artery embolization; and 7) post uterine artery embolization complications (transcervical expulsion of fibroid; non target embolization; infectious: endometritis, tubo-ovarian abscess, pyomyoma, uterine necrosis).

Conclusion
Uterine fibroids are the most common neoplasm of the female reproductive system and account for most hysterectomies in the United States. Although typical fibroids are easily recognizable, degenerating fibroids can have unusual imaging appearances. Awareness of the various appearances of leiomyomas, complications, and differential considerations is critical in making a prompt diagnosis and guiding treatment.