Multilocular cystic leiomyoma of the anterolateral abdominal wall

Abstract

Rationale:Leiomyomas arising from the anterolateral abdominal wall are uncommon, and their pathogenesis remains unknown. We present the 15th case of such a tumor, having this unique tumor morphology, followed by a detailed discussion on disease pathogenesis.Patient concerns:A 48-year-old, asymptomatic perimenopausal, multiparous Japanese woman presented with a left-sided pelvic mass. She had no history of previous surgeries or uterine leiomyomas. Although a transabdominal ultrasonogram raised suspicions of an ovarian tumor, a transvaginal ultrasonogram confirmed normal ovaries. Radiological images showed a multilocular cystic mass with enhanced solid lesions connected to the uterus. Retrospective radiological evaluation showed that the mass was largely connected to the peritoneum of the anterolateral abdominal wall.Interventions:Intraoperatively, the mass appeared as a dome-like protrusion from the left lower quadrant of the abdominal wall, without connection to the uterus, ovaries, or the left round ligament. No other peritoneal masses were seen. The mass was easily enucleated from the abdominal wall. Pathology confirmed that the mass was a leiomyoma with hydropic and myxoid degeneration. No striated muscle tissues were noted between the tumor and resection margin, but a thin smooth muscle layer, positive for hormone receptors, was present at the periphery, suggesting the origin of the tumor.Lessons:Benign leiomyomas of the anterolateral abdominal wall likely originate from Müllerian-like smooth muscle remnants in this region. They should be considered in the differential diagnosis of solid and cystic masses and be distinguished from uterine and ovarian masses on imaging to avoid unnecessary organ resection.

Unusual Location of Intraperitoneal Fibromyoma: Rarity Does Not Rule Out the Diagnosis

“…Another small fibroid in anterior wall of the uterus and myomectomy done. US, CT failed to identify the origin of the tumor due to broad attachment 10 .…”

Primary anterior abdominal wall leiomyoma in a pregnant woman

“…The exact pathogenesis of abdominal wall leiomyomas is still not well‐established . The diagnosis of primary abdominal wall leiomyoma is reached by exclusion of other sources of leiomyomas including the round ligament, the rectus sheath and the uterine leiomyomas which were subjected to previous surgery . Our patient had no surgical history or previous uterine lesions, and the tumour was completely detached from the round ligament and the rectus sheath.…”

“…Their growth depends on gene expression, fibroid cell receptors and growth factors . Accordingly, they are considered as analogous of uterine leiomyoma . This may explain the rapid growth of the tumour during pregnancy and its significant reduction in size after delivery.…”

“…4 Accordingly, they are considered as analogous of uterine leiomyoma. 5 This may explain the rapid growth of the tumour during pregnancy and its significant reduction in size after delivery. The exact pathogenesis of abdominal wall leiomyomas is still not well-established.…”

Neoplasms of the Pelvic Cavity in Pediatrics. Features of Differential Diagnosis

“…Необходим более комплексный подход с последовательным применением инструментальных методов, таких как ультразвуковое исследование (УЗИ), компьютерная томография (КТ) Акушерство и гинекология Клиническая практика (с контрастом/без контраста), магнитно-резонансная томография (МРТ), иммуногистохимическое (ИГХ) исследование. Множество клинических случаев «негинекологических» образований в предоперационном диагностическом периоде описаны как «гинекологические» [2][3][4][5][6]. И наоборот, образования, выявленные в брюшной полости, скорее всего будут связаны с гинекологической патологией [7].…”