A Rare case of cystic degeneration in uterine fibroid

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This report describes a peculiar ultrasound feature of a cystic myoma of the uterus, which simulates the sonographic appearance of a gestational sac. A 39‐year‐old woman presented for the evaluation of a pelvic mass, accompanied by pelvic pain and dysmenorrhea. The sonogram performed with a transvaginal probe showed normal bilateral ovaries. The uterus appeared lobulated in contour, and multiple fibroids were identified in the fundus, on the anterior and the posterior walls. At the level of the uterine fundus, a well-circumscribed, anechoic lesion, measuring approximately 42/37 mm, was identified, mimicking a gestational sac, next to a solid component, of 44/48 mm. The anechoic lesion did not show internal flow on Doppler sonography. Thus the diagnosis of a cystic degenerated uterine myoma or a cystic adenomyoma was suspected. The laparoscopic approach was decided to ensure diagnosis and grant the surgical treatment. The intraoperative inspection of the pelvic area showed a uterus with multiple small fibroids on the surface and into the walls, one of them, arising from the fundal area, was larger and had a white, cystic part at its end (Figure 1-3). Multiple myomectomies with uterine wall suture were performed, and the myomas were removed through morcellation. The postoperative period was uneventful, and the patient was discharged the next day.

In conclusion, as cystic degeneration of fibroids is a rare entity, observed only in 4% of leiomyomas, this frequently results in unusual clinical presentation and diagnostic dilemmas. Still, ultrasound and clinical correlation may lead to the right diagnosis.