Subserosal fibroid

Fig. 10.2.5a,b. These sagittal T2-weighted images demonstrate diffuse adenomyosis with two subserosal fibroids, a Pre UAE, the characteristic punctuate markings seen in diffuse adenomyosis (white arrow) can be seen with two fibroids (asterisks), b Post UAE, the adenomyosis has decreased in size... 

Intramural fibroids are the most common type of fibroids. Their blood supply comes from one or more nutrient arteries. As the fibroid increases in size, the nutrient artery, and the arcuate artery enlarge [4]. Submucosal fibroids also obtain their blood supply from the nutrient arteries. However, with subserosal fibroids, the fibroid may adhere to other structures, and derive blood supply from those adjacent structures [4], including the ovarian arteries. 

Fig. 10.4.6a,b. A 36-year-old woman with bulk-related symptoms, a Pre-embolization sagittal T2 weighted MRI shows a large pedunculated subserosal fibroid (F). b At 6 months post-embolization MRI shows a degenerative fibroid (F) with no volume reduction. The patient ultimately required myomectomy... 

Fibroid location within the uterus may influence the outcome of embolization. Submucosal fibroids were more likely to respond to UFE [20]. Submucosal location was a positive predictor of fibroid volume reduction after UFE [21]. The subserosal fibroids are also believed to be associated with less volume reduction after embolization (Fig. 10.5.6). 

Fig. 10.5.6a,b. Patient with a 6-cm subserosal fibroid before and after embolization, a MRl before embolization shows a large sub-serosal fibroid, b Enhanced MRI obtained 6 months after embolization demonstrates no volume change with persistent uptake... 

Some authors suggest that in the presence of a large subserosal fibroid, the laparoscopic removal needs to be offered as the first option. In patients with multiple fibroids and a large subserosal fibroid, a combined laparoscopic resection of the subserosal fibroid and UFE is a good alternative to hysterectomy. Systematic use of MRI will help with appropriate patient selection, reducing the possibility of failure after UFE. 

Katsumori T, Akazawa K, Mihara T (2005) Uterine artery embolization for pedunculated subserosal fibroids. AJR Am J Roentgenol 184 399-402... 

Fig. 5.9. MRI of leiomyoma - locations. T2-weighted coronal image of a polyfibroid uterus. A subserosal pedunculated uterine fibroid white arrow) is easily identified by its low signal intensity and continuity with the right lateral aspect of the uterine fundus while sonographi-cally the lesion could not be separated from the right ovary (black arrow). (Reproduced with permission from [223])...

The solid morphology and the signal characteristics of fibromas and fibrothecomas are fairly characteristic. Pedunculated uterine fibroids and fibroids of the broad ligaments can display similar imaging characteristics. The latter can only be differentiated from ovarian fibromas or fibrothecomas when they are separated from the ovary. Subserosal pedunculated fibroids can be discrimi-... 

Differential diagnosis includes solid ovarian tumors in younger age, e.g., granulosa cell tumors and teratomas. In MRI, uterine fibroma and fibrothecoma may display a similar appearance on T2-weighted images however, contrast enhancement in these tumors is less and delayed. Especially in CT, differentiation of subserosal uterine fibroids from solid dysgerminomas is not possible. 

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