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Figure 10c. Subserosal adenomyotic cyst in a 46-year-old woman. (a) Sagittal T1-weighted image shows a cystic mass posterior to the uterus (U). The lesion consists of a hyperintense cyst, on top of which is curvilinear tissue of intermediate signal intensity (arrows). (b) Sagittal T2-weighted image shows that the curvilinear tissue is hypointense (arrows). (c) Sagittal contrast-enhanced T1-weighted image shows the curvilinear tissue (arrows) enhancing as well as the myometrium. A pedicle containing enlarged vessels (arrowheads) connects the lesion to the uterus, indicating the uterine origin of the mass. Thus, the preoperative diagnosis was degenerated subserosal leiomyoma. (d) Photograph of the cut surface shows the hemorrhagic cystic mass and the curvilinear solid tissue (arrows). The initial pathologic diagnosis was leiomyoma because the lesion consisted of smooth muscle cells and hyaline degeneration. (e) Photomicrograph (original magnification, x40; H-E stain) shows endometrial tissue containing hemorrhage (arrow) and hemosiderin (arrowhead) lining the cyst wall.
