case_images: PMC11744594_01
case_images: Magnetic resonance imaging and intraoperative observations of the patient. (a) A sagittal T2-weighted magnetic resonance image of the pelvis shows a U-shaped uterus (red arrow) and a low-signal shadow of the fundus (red star) of the uterus, measuring approximately 4 x 3 x 3 cm and protruding beyond the vaginal orifice. (b) A T2-weighted axial image of the pelvis shows a bulls-eye appearance (red arrow). (c) The uterus on a contrast-enhanced T1-weighted magnetic resonance image shows heterogeneous enhancement (red arrow). A myoma attached to the uterus can also be seen (red star). (d) A laparoscopic image shows dilatation of the original cervical dome with an inwardly plunging uterine body. Only the fallopian tubes and ovaries are visible. (e) Under anesthesia, the entire uterus and a mass at the base of the uterus prolapsed from the vaginal orifice, and two tubal openings appeared at the base of the uterus and (f) while the assistant continuously pushed the tumor upward in the vagina, the surgeon clamped and pulled the cervix, opened the vesical peritoneal reflection and pushed the bladder downward. The surgeon then incised the lower portion of the anterior wall of the uterus and used the index finger to apply force through the incision to reposition the uterine body.
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case_images: A low-signal shadow measuring approximately 4 x 3 x 3 cm was observed beyond the vaginal orifice (Figure 1(a)). Axial imaging showed a characteristic "bull's-eye" configuration (Figure 1(b)). Contrast medium injection showed considerable enhancement of the uterine body, while minimal enhancement was observed in a low-signal shadow at the uterine fundus (Figure 1(c)). Subsequent laparoscopic exploration showed dilation of the initial cervical dome with an inwardly plunging uterine body, in which only the fallopian tubes and ovaries were discernible (Figure 1(d)), thereby confirming the diagnosis of UI. During anesthesia, complete prolapse of the entire uterus and a mass at its base were found to protrude from the vaginal orifice, accompanied by the apparent presence of two tubal openings at the base of the uterus (Figure 1(e)). Following the incision of the anterior uterine wall, successful repositioning of the uterus was achieved (Figure 1(f)), followed by a hysterosalpingo-oophorectomy.
case_images: Histology of the patient. Paraffin section pathology shows that the mass in the uterine fundus is a submucosal fundal leiomyoma with erosions.
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case_images: A histopathological examination showed a submucosal leiomyoma of the fundus with erosions (approximately 3.0 cm in diameter) (Figure 2).