Submucosal uterine leiomyomas: diagnosis of prolapse into the cervix and vagina based on MR imaging.

Abstract

We describe the MR appearance, signs and symptoms, and pathologic findings in five patients with submucosal leiomyomas that prolapsed into the cervical or vaginal canal. During the past 3 years, five women aged 33-53 years (mean, 43 years) were identified prospectively at MR imaging as having prolapsing uterine leiomyomas. The diagnosis was confirmed by surgical pathology. MR imaging was performed on a 1.5-T unit, using both T1- and T2-weighted spin-echo or fast spin-echo sequences. The images were analyzed for signal intensity, presence of a stalk, and caudal extent of the prolapsed leiomyoma. These leiomyomas, the presence of prolapse, and the caudal extent of prolapse were detected prospectively on MR images in all five cases. Prospective localization of the stalk in two cases aided subsequent hysteroscopic resection. MR imaging correctly indicated the presence of hemorrhage in one, degeneration in a second, and the absence of these complications in two others. In the fifth case, a hemorrhagic focus in the distal tip of the leiomyoma was not detected on MR images obtained 3 days before surgery. MR imaging is useful for the diagnosis and characterization of uterine leiomyomas that have prolapsed into the cervical or vaginal canal.