Cotyledonoid dissecting leiomyoma of the uterus: A report of four cases and a review of the literature

Xu, Tianmin; Wu, Shengxi; Yang, Ruiqi; Zhao, Liping; Sui, Mingxing; Cui, Manhua; Chang, Wenjuan

doi:10.3892/ol.2016.4314

Cited by 10 publications

(15 citation statements)

References 18 publications

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“…Cotyledonoid dissecting leiomyoma (CDL), also termed Sternberg tumour, 22 is a variant of uterine leiomyoma with distinctive grape-like gross appearance of an exophytic mass resembling placental tissue with about 43 reported cases in literature. 23 One case (0.06%) of this rare entity was found in our study.…”

Section: Variantsupporting

confidence: 49%

Leiomyomas in Hysterectomy Specimens: A Clinicohistopathological Study

Riyaz¹

2019

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BACKGROUNDUterine leiomyomas are the most common uterine neoplasms. They occur in as many as 75% of uteri. All women of reproductive age group are vulnerable and may experience clinical features like pain, abnormal uterine bleeding, abdominal mass and infertility or pregnancy complications, rendering knowledge of their pathogenesis and morphology essential. This study was undertaken to perform histopathological evaluation of leiomyomas. MATERIALS AND METHODS4223 hysterectomy specimens were examined for presence of leiomyomas and detailed histomorphological analysis was done for specimens with leiomyomas. RESULTSLeiomyomas were seen in 1590 (37.65%) specimens. Age of patients ranged from 22-80 years with most cases (54.53%) in 41-50 years age group and average age of 44.09 years. The most common clinical complaints were menorrhagia (45.97%), abdominal pain (18.99%), dysmenorrhea (11.95%) and abdominal mass (7.99%). Fibroid was unitary in 52.01% and multiple in 47.99% specimens. They were mostly located intramurally (80.25%). Degenerative changes like hyalinization (13.33%), hydropic degeneration (5.22%), myxoid change (2.14%), haemorrhage (1.01%), calcification (0.94%) and red degeneration were observed. Few cases of cellular, symplastic, neurilemmoma like and epithelioid variants, lipoleiomyoma, angioleiomyoma, mitotically active leiomyoma, dissecting leiomyoma and leiomyoma with hyaline globules were seen. One case was leiomyosarcoma on histopathology. Adenomyosis occurred concurrently with leiomyoma in 31.07% cases. CONCLUSIONLeiomyomas are usually present intramurally. More than half occur singly. Secondary degenerative changes and occasionally variants of leiomyoma may be encountered. Cellular, mitotically active and symplastic variants need to be differentiated from leiomyosarcoma. Adenomyosis and leiomyoma are found to coexist frequently.

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Section: Variantsupporting

confidence: 49%

Leiomyomas in Hysterectomy Specimens: A Clinicohistopathological Study

Riyaz¹

2019

jebmh

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“…On T1‐weighted images, the mass isointense compared to the adjacent myometrium 9,16,17 . The signal is increased with a contrast agent 18 . Table 3 shows the MRI characteristics reported in the most relevant articles in the literature compared to our cases evaluated by pelvic MRI.…”

Section: Resultsmentioning

confidence: 97%

“…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. Management with surgical suspicion and a study of the frozen section during surgery should therefore be considered for the possibility of a timely diagnosis.…”

Section: Resultsmentioning

confidence: 99%

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

Buonomo

Bussolaro

Giorda

et al. 2020

J of Ultrasound Medicine

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Cotyledonoid leiomyoma of the uterus is a rare variant of benign uterine leiomyoma. It has a favorable attitude, despite some ultrasound presentations. A bulky uterus with a heterogeneous mass with irregular margins, high vascularity, and infiltration of the myometrium can induce the suspicion of a malignant mesenchymal tumor and lead to a radical surgical treatment. If present, some imaging features may suggest this rare type of leiomyoma, thus avoiding extensive surgery, especially in young nulliparous women. We report 13 cases of cotyledonoid leiomyoma with clinical characteristics, imaging features, and a literature review.

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“…6 Awareness and suspicion of this entity increased its number to 43 in 2016. 3 Intense desire to save uterus and fertility made our young, nulliparous patient restless to undertake any risk at any cost.…”

Section: Discussionmentioning

confidence: 99%

“…2 At present 43 cases have been reported. 3 Our aim is to highlight a strange and alarming presentation of a unique tumor which added further confusion to the existing diagnostic puzzle.…”

Section: Introductionmentioning

confidence: 99%

A bizarre highly vascular tumor with alarming presentation: a diagnostic dilemma

Buckshee¹,

Rastogi

Deepshikha

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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An exceedingly rare, highly vascular tumor with atypical and alarming presentation posed diagnostic and management challenges. A 29 years old lady, complained of abdominal and pelvic pain, nausea, vomiting and repeated spells of fainting attacks following the jumping episode (2-3 times). Emergency admission and investigations at United States of America (USA) revealed a large, complex, highly vascular, irregular mass displaying finger like projections, filling the lower abdomen, pelvis and large amount of intra peritoneal bleed. A provisional diagnosis of arteriovenous malformation (AVM), arteriovenous fistula (AVF), and rupture/leak was made. Uterine artery angiography (UAA), preoperative embolization and possibility of hysterectomy as a life saving measure were suggested, to which the couple declined and got discharged. To save uterus and fertility they presented to us for second opinion and further management. Angiography, magnetic resonance imaging (MRI) and preoperative uterine artery embolization were done followed by exploratory laparotomy which revealed hemoperitoneum and a large weird looking vascular tumor (a veil of sea weeds/dark purple nodules of various sizes resembling cotyledons of placenta). Intra-operative tissue analysis (frozen section) suggested benign pathology. Mass was removed completely and fertility sparing surgery was undertaken. Histopathological diagnosis was cotyledonoid dissecting leiomyoma (CDL). No recurrence/metastasis has been observed on follow up of 5 years.

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Cotyledonoid dissecting leiomyoma of the uterus: A report of four cases and a review of the literature

Cited by 10 publications

References 18 publications

Leiomyomas in Hysterectomy Specimens: A Clinicohistopathological Study

Leiomyomas in Hysterectomy Specimens: A Clinicohistopathological Study

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

A bizarre highly vascular tumor with alarming presentation: a diagnostic dilemma

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