Polypoid adenomyomas: sonohysterographic and color Doppler findings with histopathologic correlation

OBJECTIVE: This study was undertaken to describe the sonographic features of polypoid adenomyomas of the uterus and to determine the diagnostic role of sonohysterography and color Doppler sonography in the evaluation of these lesions. METHODS: The sonographic findings for 46 histologically proved cases of polypoid adenomyomas of the uterus, accumulated over 10 years, were reviewed retrospectively. The pathologic diagnoses included typical polypoid adenomyoma (n = 36), atypical polypoid adenomyoma (n = 7), and low-grade adenosarcoma arising in polypoid adenomyoma (n = 3). RESULTS: Of 46 total uterine tumors, 31 were in the corpus, 12 were in the fundus, and 3 were in the isthmus. The mean tumor size was 3.5 cm (range, 0.5-9 cm). The tumors were polypoid in 30 cases, pedunculated in 11 cases, and sessile in the remaining 5 cases. Of the pedunculated tumors, 5 protruded into the endocervical canal and 2 had prolapsed into the vagina. Three distinct sonographic patterns were identified with respect to the presence of cystic areas: a solid mass (pattern 1) in 12 cases, a solid mass with cystic areas (pattern 2) in 32 cases, and a predominantly cystic mass (pattern 3) in 2 cases. The characteristic sonographic features of polypoid adenomyomas included heterogeneous or homogeneous isoechogenicity relative to the myometrium, a smooth surface, a poorly defined margin with the underlying myometrium, hemorrhagic foci, posterior shadowing, a single vascular pedicle entering the mass, and associated adenomyosis in the myometrium. CONCLUSIONS: Knowledge of the sonographic appearance of polypoid adenomyomas may facilitate diagnosis and may help distinguish these tumors from other polypoid uterine tumors.