Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
The Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
Abdom Radiol (NY). 2017 Jul;42(7):1825-1831. doi: 10.1007/s00261-017-1126-3.
Venous infarction of a leiomyoma is known as red degeneration of leiomyoma (RDL) and can be a cause of acute abdomen. Although magnetic resonance imaging (MRI) is the only modality that can depict the inner condition of a leiomyoma, the typical MR findings of RDL are sometimes identified incidentally even in asymptomatic patients. The purpose of this study is to clarify common pathological findings of uterine tumors preoperatively diagnosed as RDL by MRI.
We diagnosed 28 cases of RDL by MRI from March 2007 to April 2015. The ten lesions subjected to pathological analysis after resection were included in the study and reviewed by a gynecological pathologist. The average time from MRI to operation was 4.7 months.
The typical beefy-red color was not observed on the cut surface of the tumor except in one tumor resected during the acute phase. All lesions diagnosed as RDL by MRI had common pathological findings consistent with red degeneration of leiomyoma, including coagulative necrosis. Other common pathological features of RDL besides extensive coagulative necrosis appear to be a lack of inflammatory cell infiltrate or hemorrhage in the entire lesion.
Although RDL is known to cause acute abdomen, its typical MR findings can be observed even in asymptomatic patients in a condition that manifests long after red degeneration. The characteristic pathological findings in both the acute phase and the chronic phase that we found in this study, along with radiology reports, will be helpful references for gynecologists and pathologists in suspecting a history of red degeneration and confirming the diagnosis.
子宫肌瘤静脉梗死又称子宫肌瘤红色变性（RDL），可引起急性腹痛。虽然磁共振成像（MRI）是唯一能显示子宫肌瘤内部情况的方法，但即使在无症状患者中，也会偶然发现 RDL 的典型 MRI 表现。本研究旨在阐明术前通过 MRI 诊断为 RDL 的子宫肌瘤的常见病理表现。
我们从 2007 年 3 月至 2015 年 4 月通过 MRI 诊断了 28 例 RDL。纳入了 10 例经病理分析后切除的病变，并由妇科病理学家进行了回顾性分析。MRI 到手术的平均时间为 4.7 个月。
除了在急性期切除的一个肿瘤外，肿瘤的切面未见典型的牛肉红色。所有通过 MRI 诊断为 RDL 的病变均具有与子宫肌瘤红色变性一致的常见病理表现，包括凝固性坏死。除广泛凝固性坏死外，RDL 的其他常见病理特征似乎是整个病变缺乏炎症细胞浸润或出血。
虽然 RDL 可引起急性腹痛，但即使在红色变性后很长时间才出现症状的无症状患者中，也可观察到其典型的 MRI 表现。我们在本研究中发现的急性期和慢性期的特征性病理表现，以及放射学报告，将有助于妇科医生和病理学家怀疑红色变性病史并确认诊断。
