Cotyledonoid dissecting leiomyoma with adipocytic differentiation: A case report

Blake, Erin A.; Cheng, Georgina; Post, Miriam D.; Guntupalli, Saketh R.

doi:10.1016/j.gore.2014.10.004

Cited by 8 publications

(4 citation statements)

References 8 publications

(25 reference statements)

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“…An accurate diagnosis of CDL is challenging prior to surgery, as the distinctive grapelike (4) gross appearance of an exophytic mass resembles placental tissue and is almost always misdiagnosed clinically as an ovarian tumor or uterine sarcoma (5)(6)(7)(8). The majority of patients with CDL are diagnosed during an exploratory laparotomy (1,(9)(10)(11), and a frozen section is recommended to be used for the diagnosis of CDL (7,9). In the literature, to preserve fertility, the recommended treatment is resection of intrauterine tumors by myomectomy and extrauterine tumors by excision (1,5,12,13).…”

Section: Introductionmentioning

confidence: 99%

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

Yang

et al. 2016

Oncology Letters

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Abstract. Cotyledonoid dissecting leiomyoma (CDL), also termed Sternberg tumor, is a variant of uterine leiomyoma that is rarely diagnosed by clinical evaluation. At present, ~43 cases of CDL have been reported in the literature written in the English language. Due to the distinctive grapelike gross appearance of an exophytic mass resembles placental tissue, CDL is often misdiagnosed clinically as an ovarian tumor or uterine sarcoma. Therefore, an awareness of the features of the disease is important to prevent misdiagnosis and overtreatment. The present study reports 4 cases of CDL of the uterus that were treated at the Second Hospital of Jilin University between January 2009 and December 2011. All 4 patients in the current study presented with a palpable asymptomatic pelvic mass, which was detected during physical examinations, and cancer antigen 125 tumor marker levels that were within the normal range. The exploratory laparotomy of the 4 patients revealed lobulated tumors with a grapelike appearance extending from the lateral uterine wall into the ligament or the adjacent tissues. The frozen section and postoperative pathology were diagnosed as CDL. A total abdominal hysterectomy was performed in the first case of a 55-year-old woman that had been in menopause for 7 years. The patient was well and showed no evidence of disease subsequent to 48 months of follow-up. A total abdominal hysterectomy and right salpingo-oophorectomy were performed in the second case of a 43-year-old woman, who was well and showed no evidence of disease subsequent to 26 months of follow-up. A subtotal abdominal hysterectomy and bilateral salpingectomy were performed in the third case of a 37-year-old woman, who was well and showed no evidence of disease subsequent to 27 months of follow-up. A total abdominal hysterectomy and right-salpingectomy were performed with the removal of a retroperitoneal fibroid extension in the fourth case of a 48-year-old woman, who was well and showed no evidence of disease subsequent to 32 months of follow-up.

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Section: Introductionmentioning

confidence: 99%

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

Yang

et al. 2016

Oncology Letters

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“…Moreover, the histopathologic differential diagnosis includes not only malignant forms but also disease variants. Histologic variants of CL/CDL reported in the literature include the following: (1) a form lacking the intramural component; (2) an intramural myoma that shows intramural dissection but lacks any extrauterine component; (3) a cotyledonoid hydropic intravenous leiomyoma 25 ; (4) an epithelioid variant 12; and (5) a type with adipocytic differentiation 26 . Foci of neoplastic leiomyomatosis tissue filling the lumen of veins can be present in the focal intravascular intrusion of the tumor masses (CDL with intravascular growth) 27 …”

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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“…Over 30 cases of this tumour have been reported up to this date in the published literature, one of which had described the presence of adenomyosis within the tumour. [3] Uterine cotyledonoid dissecting leiomyomas with intravascular luminal growth, [4] epithelioid variant, [5] hydropic variant [6] and CDL with adipocytic differentiation [7] have also been described. The present case is the second described case in the published literature of a CDL in which non-neoplastic endometrial glands with endometrial stromal cells are present together with an intravascular luminal growth component.…”

Section: Discussionmentioning

confidence: 99%

Cotyledonoid dissecting leiomyoma with intravascular growth pattern and intra-tumoural endometrial glands and stroma: A case report

Merchant

Chern

Chew

2017

CRCP

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Cotyledonoid dissecting leiomyoma (CDL) is a rare variant of leiomyoma which shows a dissecting growth pattern of smooth muscle cells within the myometrium, with or without extra-uterine extension, and a macroscopic appearance resembling placenta. We present a unique case of CDL with both intravascular growth and presence of endometrial glands and stroma within the tumour. A 35-year-old female patient presented with menorrhagia. Ultrasound examination revealed a bulky anteverted uterus with a prolapsed submucosal leiomyoma and an intramural leiomyoma. In the interest of preserving fertility, she underwent myomectomy together with laparoscopic resections of the uterine wall deposit and myometrial tissue. The tumour was soft and pink, with a resemblance to placental tissue, and histology demonstrated nodules of neoplastic smooth muscle cells with areas of oedema and myxoid change dissecting into the surrounding myometrial tissue, which is consistent with the features of CDL. Also seen were non-neoplastic endometrial glands cuffed by stroma located within the smooth muscle tumour as well as in the non-neoplastic myometrium. There were foci of intravascular luminal growth confirmed by positive CD31 immunohistochemical staining of the endothelial cells lining the vascular lumina. The present case demonstrates that CDLs may have a unique histological appearance resembling adenomyoma and an intravascular growth pattern. It is important for pathologists, gynaecologists and radiologists to recognize such smooth muscle tumour variants and hence prevent misdiagnosis of malignancy and overtreatment.

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Cotyledonoid dissecting leiomyoma with adipocytic differentiation: A case report

Cited by 8 publications

References 8 publications

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

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

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

Cotyledonoid dissecting leiomyoma with intravascular growth pattern and intra-tumoural endometrial glands and stroma: A case report

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