EC Gynaecology

Uterine fibroids are the most common benign gynaecological tumors in women of reproductive age and remain the first cause of hysterectomy in women before menopause, with an estimated 0.1 - 0.8% risk of malignant transformation into sarcomas. Uterine fibroids may be responsible for a variety of symptoms including menorrhagia, pelvic pain, and compression symptoms when the myoma is very large, or be entirely asymptomatic. But, the large mass is still very rare. Abdominal and endovaginal pelvic ultrasound is the initial imaging method for the diagnosis of uterine fibroids, but it is not specific, especially in case of abdominal-pelvic mass. In case of diagnostic issues, multiple fibroids, large fibroids, degeneration, or as part of the pre-treatment assessment (conservative treatments), pelvic magnetic resonance imaging (MRI) is the modality of choice, thanks to its excellent tissue resolution and better interobserver reproducibility. We report here the case of a large fibroma with cystic and malignant degenerative changes, mimicking ovarian carcinoma on ultrasound, in a 46-year-old nulligravida and nulliparous woman, whose diagnosis is made by MRI. Our article aims to highlight the value of MRI in the diagnosis of this entity, with an emphasis on the typical and atypical radiologic imaging features of uterine fibroids the pitfalls, and mimics, to suggest an appropriate therapeutic approach.

Keywords: Large Uterine Fibroids; Abdominal Pelvic Mass; Ultrasound; Magnetic Resonance Imaging; Degeneration

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