One case report of giant atypical leiomyoma of the ovary

Abstract

Rationale:Ovarian leiomyoma is a rare ovarian tumor that occurs in 20–65 year-old women, and is mostly misdiagnosed as malignant tumor. In most reports on this type of tumor, ovarian myoma has a benign histology. Herein,we describe a case of ovarian atypical leiomyoma.Patient concerns:The patient is a 58-year-old woman. At the age of 40 years old, the patient underwent hysterectomy due to “hysteromyoma” and secondary anemia. The patient was admitted to our hospital due to palpation of lower abdominal mass and abdominal distention.Diagnoses:A mass was revealed at the left uterine appendage by pelvic ultrasound and CT.Pathology and immunohistochemistry confirmed the diagnosis of the left ovarian atypical leiomyoma.Interventions:Pelvic cavity resection and right adnexectomy were performed during laparotomy for the patient.Outcomes:Without radiotherapy or chemotherapy, there were no signs of tumor recurrence in a 9-month follow-up period.Lessons:When a solid mass appears in ovarian tissues, ovarian leiomyoma should be considered. Patients with this type of tumor are mostly asymptomatic. Preoperative diagnosis was difficult, intraoperative frozen section would be helpful for determining the scope of the surgery, and the correct diagnosis was made by identifying the properties of smooth muscles through postoperative pathology and immunohistochemistry.

Cystic Ovarian Leiomyoma in a Patient with Progressive Abdominal Pain

“…They reportedly account for 1% of all ovarian tumors. Most ovarian leiomyomas have benign histology but can range from benign to borderline to malignant [ 3 , 4 ]. In a few cases, estrogen and progesterone have been reported to play a role in the development and progression of ovarian leiomyomas.…”

“…When the tumors are sizable, however, they can present with non-painful abdominal swelling or, less often, minimal abdominal pain. On rare occasions, the tumors can cause compression, resulting in symptoms of urinary frequency and constipation [ 1 – 3 ]. Moreover, ovarian leiomyomas can be primary or secondary, based on the time of presentation.…”

“…Some scholars theorize that they arise from smooth muscle cells in the ovarian ligament or stroma. Others believe that the tumors develop from undifferentiated reproductive cells and cortical smooth muscle cells, or from smooth muscle cells in the form of metaplasia or ovarian endometriosis [ 3 ]. Ovarian leiomyomas that develop from tissues external to the ovaries and come into contact with the ovaries are referred to as secondary.…”

“…Performing frozen section histopathology intraoperatively in cases of suspected ovarian leiomyoma is important, as the results provide a better understanding of the type of tumor and help guide surgical decisions. In our patient’s case, intraoperative chemotherapy had been planned but was not given because the frozen section results showed fibrous inflammation with giant cells and no evidence of malignancy [ 3 ]. The postoperative pathology report resulted in a diagnosis of leiomyoma with cystic degeneration.…”

“…Most patients with ovarian leiomyomas have no symptoms because of the small size of the tumors and the incidental nature of their discovery. Some patients, however, present with abdominal pain with or without distention [ 3 ]. Most women with ovarian leiomyomas have a history of uterine leiomyoma and hysterectomy [ 2 ].…”