Intramural leiomyoma

Miettinen M, Furlong M, Sarlomo-Rikala M, et al. Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the rectum and anus a clinicopathologic, immunohistochemical, and molecular genetic study of 144 cases. Am Surg Pathol. 2001 25 1121-1133. 

Fig. 5.1. Macroscopic pathology of leiomyoma. Macroscopic uterine specimen showing a single intramural leiomyoma in the wall of the uterine corpus abutting the endometrial cavity and deforming the outer contour of the uterus. A surrounding pseudocapsule of compressed myometrium can also be depicted...

Fig. 5.15. Bridging vascular sign in a pedunculated leiomyoma. Tl-weighted contrast-enhanced fat-suppressed sagittal image depicts a large pedunculated subserosal leiomyoma originating from the uterine fundus. Flow-voids are seen within the vessel stalk (arrow). A second intramural leiomyoma in the anterior wall is seen displacing the endometrial stripe. (Reproduced with permission from [223])...

Depending on their location, leiomyomas can be resected or enucleated using a hysteroscopic or laparoscopic access or open laparotomy. Hysteroscopic resection is suitable to remove submucosal leiomyomas. Hysteroscopic resection is generally considered unsuitable for submucosal leiomyomas larger than 5 cm in size, if more than three fibroids are present, or if the uterine cavity is very large (length of uterine probe > 12 cm). Moreover, the size of the intramural... 

Magnetic resonance imaging (MRl) is the most accurate diagnostic modality for assessing uterine leiomyomas [37]. MRI enables assessment of the uterus in multiplanar orientation and without interference from superimposed structures. MRI provides not only accurate information on the number and size of fibroids but also on their location within the uterus (cervix, corpus, fundus) and within the wall (submucosal, intramural. 

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