Background: Polypoid endometriosis (PEM) is a rare type of endometriosis, frequently mimicking a malignant tumor. We report on a patient with PEM over a 10-year span who had symptoms at age 16. Case: A 20-year-old woman presented with massive vaginal hemorrhage and spontaneous abortion, having symptoms of dysmenorrhea, anal distending pain, and vaginal bleeding since adolescence. Imaging showed multiple polypoid neoplasms of the rectum and vagina connecting to the huge mass in a cul de sac. After exploration and excision, the pathology revealed PEM.
In this pictorial review, MR imaging findings of deep infiltrating endometriosis (DIE) are illustrated together with surgical correlation. DIE can appear as irregular nodules or plaques with similar signal intensity to muscle on both T1-weighted and T2-weighted images. Hemorrhage foci and strands or stellate margins are also often noted. Restriction of diffusion can be seen on diffusion-weighted image. Fibrosis and adhesions often result in morphologic changes, such as alimentary tract tortuosity, irregular or nodular thickening of uterosacral ligaments, and partial or complete obliteration of the pouch of Douglas. After intravenous gadolinium contrast agent administration, homo- or heterogeneous mild to moderate enhancement can be observed. MR imaging can depict endometriosis lesions and extension of DIE at different anatomic locations, which is well consistent with surgical findings. Combining signal and morphological abnormalities, MR imaging can diagnose and assess the extension of DIE with high accuracy. MR imaging findings of DIE facilitate surgeons at treatment decision making and patient communication.
Malignant fibrous histiocytoma commonly occurs spontaneously. In some cases it follows previous therapeutic or incidental irradiation, or miscellaneous pre-existing osseous conditions. Recently, it has been associated with total hip arthroplasty. We report a case of malignant fibrous histiocytoma following radiation therapy of fibrous dysplasia and review the relevant literature.
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