Cotyledonoid Dissecting Leiomyoma with Symplastic Features: Case Report

Abstract

Purpose Cotyledonoid dissecting leiomyoma is a leiomyoma variant exhibiting unusual growth patterns. We aimed to demonstrate this, as well as to point out another feature that has not been previously reported. Case Report A congested, multinodular myomectomy specimen was resected. Histologically, smooth muscle fascicles with marked vascularity and extensive hydropic degeneration were detected. A total of 2 mitoses per 10 high power fields were counted, and the K i -67 index was of 2-3%. We encountered atypical bizarre cells that have not been previously reported. Coagulative necrosis was not present. The patient was alive and well 36 months after surgery, with no evidence of recurrence. Conclusions Albeit the gross aggressive appearance, cotyledonoid dissecting leiomyomas are benign in nature. To this day, atypical cells have not been reported in this type of tumor. Despite the presence of symplastic features, cotyledonoid dissecting leiomyomas are clinically benign entities. Surgeons and pathologists should be acquainted with this variant. ResumoIntrodução O leiomioma dissecante na forma cotiledonoide é uma variante de leiomioma com padrões raros de crescimento. Além de demonstrá-los, vamos apontar outro aspecto anteriormente não relatado. Relato de Caso Uma amostra congestionada, multinodular de miomectomia foi excisada. Histologicamente, detectaram-se fascículos de músculos lisos com marcada vascularidade e extensa degeneração hidrópica. Contaram-se 2 mitoses por 10 campos de alta potência, e o índice K i -67 foi de 2-3%. Encontramos células atípicas, bizarras, que não haviam sido relatadas anteriormente. Não foi observada necrose coagulativa. A paciente encontrava-se saudável e sem evidências de recorrência 36 meses após a cirurgia.

Cotyledonoid Leiomyoma Clinical Characteristics, Imaging Features, and Review of the Literature

“…Hydropic and hyalinizing degeneration and even its association with classic leiomyomas of the uterus can be observed, 22 as in our series. The literature has reported the microscopic examination as characterized by benign features: no atypical cells and no signs of mitotic activity or cell necrosis, except for 1 case that showed atypical, mononuclear/multinuclear, and bizarre cells in the surgical specimen 23 . A frozen intraoperative section is suggested by many authors to avoid radical surgery for a potentially benign lesion, 24 especially in young women, as described in a recent case report 18 : 4 cases of CDL were correctly diagnosed by an extemporaneous intraoperative examination.…”

The Management of the Cotyledonoid Leiomyoma of the Uterus: A Narrative Review of the Literature

“…No signs of malignancy appear under microscopy: no atypical cells, no signs of increased mitotic activity, no coagulating tumor necrosis. In only one case [47], symplastic features were detected, because of the presence of mononuclear and multinuclear atypical, bizarre cells. Despite these atypical microscopic features, no evidence of recurrence was observed after a 36 month follow-up.…”