Benign Conditions of the Vagina Cervix and Uterus

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Cysts Cervix Pictures

Fig. 5. Nabothian cysts (arrows) of the cervix. a Ultrasound b T2-weighted MR image

Bartholin's cysts are caused by retained secretions within the vulvo-vaginal glands, mostly as a result of chronic inflammation or trauma. They are located in the posterolater-al parts of the lower vagina and vulva, whereas Nabothian Cysts are retention cysts of the cervical glands and clefts.

Leiomyomas (also known as fibroids and fibromy-omas) are benign neoplasms of smooth-muscle cell origin and are the most common uterine tumors (Fig. 5-7).

Fig. 5. Nabothian cysts (arrows) of the cervix. a Ultrasound b T2-weighted MR image

Fig. 7. Multiple uterine leiomyomas. Sagittal T2-weighted and contrast-enhanced T1-weighted image. The multiple lesions are sharply demarcated. They present as hypointense lesions on the T2-weighted sequence. Contrast-enhancement is less pronounced compared to the adjacent normal myometrium. A signal void is indicative of calcification (arrow)

Fig. 6. Coronal T2-weighted FSE MR image. Small hypointense leiomyoma (arrow) in a bicornuate uterus

Fig. 7. Multiple uterine leiomyomas. Sagittal T2-weighted and contrast-enhanced T1-weighted image. The multiple lesions are sharply demarcated. They present as hypointense lesions on the T2-weighted sequence. Contrast-enhancement is less pronounced compared to the adjacent normal myometrium. A signal void is indicative of calcification (arrow)

The lesions must be differentiated from focal adeno-myosis (Fig. 8). Ultrasound remains the primary imaging modality for clinically suspected leiomyomas, and in the vast majority of routine clinical presentations no additional investigation is needed. MRI is recommended in selected cases as a problem-solving modality, e. g., to distinguish between a pedunculated leiomyoma and a solid ovarian mass, to demonstrate the exact size and location of the lesion (subserosal, intramural, submucosal) before uterine-sparing surgery or for selecting candidates for

Fig. 8. Focal adenomyosis (T2-weighted images). Enlarged uterus with diffusely thickened junctional zone with multiple hyperin-tense foci indicative of adenomyoma. A small leiomyoma can also be seen (arrow)

uterine artery embolization, as well as to distinguish leiomyoma from adenomyoma.

Most leiomyomas have a typical appearance on MRI. They are depicted as sharply marginated, hypointense lesions not only on T1-, but also on T2-weighted sequences. Low-signal intensity on T2-weighted images permits differentiation from malignant tumors. Leiomyomas, especially when large and during pregnancy, may undergo degenerative changes such as necrosis, resulting in various, non-specific MR appearances.

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