Ultrasonic “honeycomb” appearance of uterine submucous fibroids undergoing cystic degeneration

Abstract

Uterine fibroids are the most common of uterine benign tumors. Generally, the ultrasonic appearance of uterine fibroids is typical, and diagnosis is uncomplicated. However, the sonographic characteristics of fibroids undergoing cystic degeneration, and especially those of the submucous type, may be misleading. We present a series of submucous fluids with cystic degeneration in peri- and postmenopausal women showing a distinct sonographic "honeycomb" pattern erroneously diagnosed as endometrial hyperplasia. The correct diagnosis was established by hysteroscopy.

Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group

“…There is usually no internal vascularity or, at most, a few disparate vessels are observed. Cystic or myxoid degeneration may develop, resulting in regular hypoechogenic cystic areas with fluid or myxoid content. Degeneration may also occur in malignant uterine smooth muscle tumors.…”

Rapidly growing leiomyoma in a postmenopausal woman

“…There have been a few reports of growing uterine myomas after menopause. To our knowledge, several cases of lipoleiomyomas 4–10 and cystic degenerative changes, 11,12 characteristic of leimyoma have been reported previously. The incidence of lipoleiomyoma varies from 0.03% 4 to 0.12% 7 of all leiomyomas.…”

“…However, there have been few reports of the cystic degeneration of leiomyomas after menopause 11,12 . Cystic degeneration indicates a liquefaction of hyalinized areas due to a decreased blood supply.…”

Degenerating Cystic Uterine Fibroid Mimics an Ovarian Cyst in a Pregnant Patient

“…2 Uterine fibroids are characterized by a homogeneous or heterogeneous hypoechoic uterine mass, but with cystic degeneration, a fibroid has a variable sonographic appearance. It can mimic an ovarian cyst, 4 endometrioma, 5 abscess, 6 and endometrial hyperplasia. 7…”