Magnetic Resonance Imaging and Pathologic Findings of 26 Cases With Uterine Adenomatoid Tumors

Abstract

To analyze the magnetic resonance imaging (MRI) features and pathologic findings of uterine adenomatoid tumors (ATs) for improved diagnostic accuracy and facilitating differential diagnosis of the tumors. We investigated retrospectively 26 patients with uterine ATs confirmed by pathology. Before operation, all patients accepted multiple MRI scans, including T1-weighted image (T1WI), T2-weighted image (T2WI), T2WI/spectrally adiabatic inversion recovery, and T1-weighted enhanced imaging. Two radiologists reviewed all the MRI sequences on PACS workstations for all patients to evaluate the location, shape, size, margin, intensity, and enhancement of ATs. All uterine ATs exhibited either single round solid (n = 24) or predominantly cystic (n = 2) masses with either well-defined (n = 23) or ill-defined margin (n = 3). The diameter range of the tumors was 1.0 to 7.0 cm (mean, 3.8 cm). Solid masses were isointensive on T1WI and hypointensive on T2WI with moderate enhancement. The degree of enhancement in solid tumors was either lower than (18/24 [75%]) or equal to (6/24 [25%]) that of the myometrium. Predominantly cystic masses presented as cystic lesions with a little irregular solid nodule inside. The cystic parts were hypointensive on T1WI and hyperintensive on T2WI without enhancement, whereas the solid nodules were isointensive on both T1WI and T2WI with moderate enhancement. A large part of the uterine ATs (69.2% [18/26]) coexisted with other uterine diseases. On pathology, uterine ATs were characterized as gland-like structures with irregular expansion of tubular cavities, which might be correlated with low enhancement of tumors. The tumors were lined with flat or cuboidal mesothelial cells and residue of smooth muscle component, which might contribute to their hypointensive appearance on T2WI. Small solid uterine masses with homogeneous hypointensity on T2WI and lower enhancement or cystic lesions with inner irregular solid nodule may indicate the diagnosis of uterine ATs, and final diagnosis can be determined with pathology.