title: Magnetic resonance imaging findings in atypical polypoid adenomyoma.
abstract: OBJECTIVE
  This article describes magnetic resonance imaging (MRI) findings in 3 cases of atypical polypoid adenomyoma (APAM).
  
  
  METHODS
  Clinical and MRI manifestations of 3 patients with APAM were evaluated. High b value diffusion-weighted and dynamic contrast-enhanced images were performed. The size, shape, site of origin, and signal intensity (SI) of MRI findings were evaluated.
  
  
  RESULTS
  All patients (age range, 37-47 years; mean age, 40 years) had a chief complaint of atypical genital bleeding with no history of pregnancy. In 2 cases, cytology of the endometrium was positive, and pathological analysis of curettage specimens indicated endometrioid adenocarcinoma. The MRI revealed an endometrial polypoid mass arising from the upper corpus (50%) or lower uterine segment (50%). Except for 1 tumor that seemed to invade the myometrium of the uterine wall due to its irregular margin, all tumors were well circumscribed. On T2-weighted MRI scans, the SI of the tumor was homogenous and marginally hyperintense, and contained markedly hyperintense cystic foci. On T1-weighted images, all the tumors were isointense relative to the myometrium, and in 1 case, a number of cystic foci showed high SIs. In a dynamic contrast-enhanced study, solid portions other than the cystic foci showed contrast enhancement in the arterial phase and demonstrated a washout pattern or plateau pattern in the late phase. All tumors demonstrated high SIs on diffusion-weighted images.
  
  
  CONCLUSIONS
  Differentiating APAM from other malignant polypoid uterine endometrial tumors may still pose difficulties, especially when the tumor seems to invade the myometrium on MRI. Comprehensive clinical information about the patient including age, pathological assessment of the endometrium, and MRI findings should be essential to provide indication for a diagnosis of APAM.
authors.affiliation: From the Departments of *Radiology, †Pathology, ‡Obstetrics and Gynecology, Osaka Medical College, Takatsuki City, Osaka, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Nakai
authors.forename: Remi
authors.initials: R
authors.lastname: Kitano
authors.forename: Kiyohito
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Akira
authors.initials: A
authors.lastname: Higashiyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Juri
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuboyama
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamada
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Hirose
authors.forename: Masahide
authors.initials: M
authors.lastname: Ohmichi
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Narumi
mesh_terms: D018194:Adenomyoma / Q000150:complications* / Q000473:pathology*; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D014592:Uterine Hemorrhage / Q000209:etiology* / Q000473:pathology*; D014594:Uterine Neoplasms / Q000150:complications* / Q000473:pathology*