RESUMEN
In the few articles describing MRI findings of myxoid leiomyosarcoma (MLMS), high signal intensity (SI) on T2-weighted images (T2WI) due to myxoid change was believed to be one of the common features. However, we encountered an MLMS with low SI similar to uterine myometrium on T2WI that subsequently grew with extremely edematous change even after 3 cycles of gonadotropin-releasing hormone agonist (GnRHa) treatment. Here we present this atypical MLMS case with radiologic-pathologic correlation. The patient was a 46-year-old woman with a chief complaint of low abdominal pain. The tumor was a pedunculated mass arising from the right anterior wall of the uterus that included a low-SI tumor-like component that partially transitioned into a peripheral high-SI component on T2WI and was diagnosed as hydropic leiomyoma. After 3 cycles of GnRHa therapy, the tumor size increased along with the size of the peripheral high-SI component on T2WI, while the size of the low-SI tumor-like component decreased. A small markedly low-SI area on both T1 and T2WI and a subtle high-SI area on fat-saturated T1WI indicating hemorrhage were present within the tumor. Pathologically, not only the peripheral high-SI component but also the low-SI tumor-like component on T2WI corresponded to MLMS, and the high-SI component was associated mainly with edematous change rather than myxoid change. MLMS may initially show low SI on T2WI and change to high SI mainly due to edematous change with rapid growth. Intratumoral hemorrhage might be the only key feature to differentiates MLMS from hydropic leiomyoma.
RESUMEN
Although imaging studies are not typically performed for clinical diagnosis of cervicitis, in this case magnetic resonance imaging (MRI) was performed because a lesion with a tumor-like gross appearance was found in the uterine cervix. We present a case of cervicitis in which clinical, imaging and pathological features overlapped with those of gastric-type mucinous adenocarcinoma (GAS). The patient, a 30-year-old woman, was referred to a gynecologist with a complaint of watery vaginal discharge. On visual examination, the uterine cervix was irregularly enlarged and bled easily, suggesting cervical cancer. The next day, the patient had a fever of 39°C and blisters appeared on her vulva due to herpes simplex virus type II infection. MRI showed a diffusely enlarged cervix with poorly marginated high signal intensity on T2-weighted imaging (WI) and apparent diffusion coefficient map as well as strong enhancement on contrast-enhanced T1WI, which are findings consistent with GAS. Although a punch biopsy showed only mild atypia of the cervical glands, this was not enough to completely rule out GAS. Consequently, laser conization of the lesion was performed for definitive diagnosis, and the diagnosis of cervicitis was made. Acute cervicitis can be difficult to differentiate from GAS based on symptoms, results of cervical biopsy and MR imaging because of their overlapping features. Even when a patient presents with a lesion with tumor-like gross appearance, acute cervicitis should be included in the differential diagnosis if the result of cervical biopsy is negative, especially when accompanied by infection-like fever.