Imaging Sciences Interesting Cases
Case 75
Sara Ann Majewski, MD
Clinical Presentation: Patient is a 42-year-old female complaining of heavy vaginal bleeding. Gynecologic exam revealed a mass protruding through the cervix. This mass was imaged on ultrasound and later removed.
Imaging Findings: Vascular, hypoechoic tissue extending into the cervix and connecting to the endometrium which most likely represents a fibroid. Differential diagnoses include polyp or malignancy.
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| Figure 1. Sagittal transvaginal grayscale ultrasound image of the pelvis shows a mass protruding through the cervix which is hypoechoic to the cervix and continuous with endometrium. (Move mouse over image to view labels.) |
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| Figure 2. Sagittal transvaginal ultrasound image with color Doppler flow of the pelvis shows flow within the mass. |
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| Figure 3. Transverse transvaginal grayscale ultrasound image of the pelvis shows a mass protruding through the cervix which is hypoechoic to the cervix (in cursors). |
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| Figure 4: Transverse transvaginal grayscale ultrasound image of the pelvis shows flow within the mass. |
Diagnosis: Uterine Leiomyoma
Discussion: The cervix is best visualized transvaginally.
Differential diagnosis of a mass protruding through the cervix includes cervical polyps, leiomyomas, cervical stump pseudomass, cervical carcinoma and adenoma malignum.
Cervical polyps frequently cause vaginal bleeding and are typically a clinical diagnosis.
About eight percent of leiomyomas develop in the cervix and can be pedunculated, prolapsing into the vagina.
After hysterectomy, the cervical stump can look like a mass and can be evaluated by transvaginal sonography.
Cervical carcinoma is usually diagnosed clinically, but sonography can show a solid mass posterior to the bladder which can be indistinguishable from a cervical fibroid. CT and MRI are used for staging purposes.
Adenoma malignum is a rare cervical neoplasm developing from the endocervical glands. In many cases, this is associated with Peutz-Jeghers. Numerous cystic areas are seen in a solid cervical mass. This is different from nabothian cysts which have no associated mass.
References:
- Rumack C, Wilson S, Charboneau JW, Johnson J-A. Diagnostic Ultrasound. 3rd ed., St. Louis: Mosby, 2005.