Systems and methods for generating a synthesized medical image are provided. An input medical image is received. A synthesized segmentation mask is generated. The input medical image is masked based on the synthesized segmentation mask. The masked input medical image has an unmasked portion and a masked portion. An initial synthesized medical image is generated using a trained machine learning based generator network. The initial synthesized medical image includes a synthesized version of the unmasked portion of the masked input medical image and synthesized patterns in the masked portion of the masked input medical image. The synthesized patterns is fused with the input medical image to generate a final synthesized medical image.