Prolapsed endometrial polyp

Case contributed by Dr Ammar Haouimi

Presentation

Menometrorrhagea.

Patient Data

Age: 40 years
Gender: Female
Ultrasound

Echogenic mass prolapsing into vagina through a distended cervical canal.

MRI

Well-defined pedunculated intracavitary uterine mass arising from the fundus (measuring 45 x 35 x 25 cm) prolapsing into vagina through a distended endocervical canal. It displays an isosignal to the endometrium on T1 and T2, with a heterogeneous enhancement on post-contrast sequences. No infiltration of the myometrium. No pelvic lymphadenopathy. Mild effusion in Douglas pouch.

Normal appearance of the ovaries with small follicles.

Bilateral hip avascular necrosis (known).

Case Discussion

The MRI features are most consistent with an endometrial polyp.

On imaging, the main differential diagnosis is uterine leiomyoma, especially the pedunculated form, but usually tend to be hypoechoic on ultrasound and hypointense signal on MRI.

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