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Fig. 11B. —37-year-old woman with IV leiomyomatosis. Axial T2-weighted image (2,000/80) caudal to A shows that parametrial mass extends out from uterine mass. Pathology confirmed diagnosis of IV leiomyomatosis. IV leiomyomatosis is characterized by growth of histologically benign smooth muscle initially into venous channels within broad ligament and then into uterine and iliac veins. This IV growth takes form of visible, wormlike projections extending out from a myomatous uterus into parametria toward pelvic sidewalls. IV extension of endometrial stromal sarcoma must be considered in differential diagnosis.