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Magnetic resonance imaging findings in atypical polypoid adenomyoma
Go Nakai1, Remi Kitano, Kiyohito Yamamoto
1From the Departments of *Radiology, †Pathology, ‡Obstetrics and Gynecology, Osaka Medical College, Takatsuki City, Osaka, Japan.
Objectives:
This article describes magnetic resonance imaging (MRI) findings in 3 cases of atypical polypoid adenomyoma (APAM).
Methods:
Clinical and MRI manifestations of 3 patients with APAM were evaluated. High b value diffusion-weighted and dynamic contrast-enhanced images were performed. The size, shape, site of origin, and signal intensity (SI) of MRI findings were evaluated.
Results:
All patients (age range, 37-47 years; mean age, 40 years) had a chief complaint of atypical genital bleeding with no history of pregnancy. In 2 cases, cytology of the endometrium was positive, and pathological analysis of curettage specimens indicated endometrioid adenocarcinoma. The MRI revealed an endometrial polypoid mass arising from the upper corpus (50%) or lower uterine segment (50%). Except for 1 tumor that seemed to invade the myometrium of the uterine wall due to its irregular margin, all tumors were well circumscribed. On T2-weighted MRI scans, the SI of the tumor was homogenous and marginally hyperintense, and contained markedly hyperintense cystic foci. On T1-weighted images, all the tumors were isointense relative to the myometrium, and in 1 case, a number of cystic foci showed high SIs. In a dynamic contrast-enhanced study, solid portions other than the cystic foci showed contrast enhancement in the arterial phase and demonstrated a washout pattern or plateau pattern in the late phase. All tumors demonstrated high SIs on diffusion-weighted images.
Conclusions:
Differentiating APAM from other malignant polypoid uterine endometrial tumors may still pose difficulties, especially when the tumor seems to invade the myometrium on MRI. Comprehensive clinical information about the patient including age, pathological assessment of the endometrium, and MRI findings should be essential to provide indication for a diagnosis of APAM.
Insights
Magnetic resonance imaging (MRI) can help diagnose atypical polypoid adenomyoma (APAM), a rare uterine tumor. Differentiating APAM from endometrial cancer using MRI requires careful analysis of imaging features and clinical data.
Area of Science:
- Gynecologic imaging
- Uterine pathology
- Diagnostic radiology
Background:
- Atypical polypoid adenomyoma (APAM) is a rare uterine tumor that can mimic endometrial cancer.
- Accurate diagnosis is crucial for appropriate patient management.
Observation:
- This study evaluated MRI findings in 3 cases of APAM.
- MRI revealed polypoid endometrial masses with specific signal intensities and enhancement patterns.
- Key features included homogenous to marginally hyperintense T2 signal, hyperintense cystic foci, and contrast enhancement with washout or plateau patterns.
Findings:
- MRI demonstrated well-circumscribed endometrial polypoid masses in most cases.
- T2-weighted images showed homogenous signal with hyperintense cystic foci.
- Dynamic contrast-enhanced MRI revealed arterial phase enhancement and washout/plateau patterns.
- Diffusion-weighted imaging showed high signal intensity in all tumors.
Implications:
- Differentiating APAM from malignant polypoid endometrial tumors on MRI can be challenging, particularly with apparent myometrial invasion.
- Integrating MRI findings with clinical information, patient age, and pathological assessment is essential for diagnosing APAM.
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