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

Abstract

Cotyledonoid leiomyoma is an unusual uterine myoma due to some ultrasound features that mimic a malignant lesion facilitating the choice of radical surgery. This study aims to summarize the ultrasound and the magnetic resonance imaging aspects of this atypical lesion, and also discuss surgical treatment and pathological exam. It included all English case reports or case series until August 2021 found through PubMed, Google Scholar, and Scopus. A total of 94 cotyledonoid leiomyomas were reported, with a median tumor size of 12 cm. The typical ultrasound image is characterized by a large solid heterogeneous mass, with high vascularity, no shadowing, and indistinct margins within the myometrium. Magnetic resonance imaging shows the presence of merging isointense nodules to the myometrium in T1-weighted images, hyperintense in T2-weighted images, and contrast agent enhancement. Surgical treatment consists of hysterectomy (75 cases, 80%) or myomectomy (19 cases, 20%), without evidence of recurrence if complete. The placenta-like appearance observed during surgery supports this rare fibroid hypothesis. The intraoperative frozen section can be considered. Microscopically, no atypical cells, signs of mitotic activity or cell necrosis are found. To conclude, some preoperative and intraoperative aspects of this lesion are distinctive and may lead surgeons to opt for conservative surgery.

Case report: cotyledonoid dissecting leiomyoma in a 49-year-old woman

“…The patient in this study had experienced progressive constipation for 6 months. The tumor size of CDL has been found to vary between 4 and 43 cm, and the size decreases with increasing age, likely due to the hormone depletion ( 6 ).…”

“…There was no clear boundary between the CDL and myometrium on the cut surface ( 7 ). Regarding tumor markers, serum CA125 levels of CDL cases have been reported as being slightly increased or within normal limits ( 6 ).…”

Cotyledonoid Dissecting Leiomyoma: A Rare Variant of Leiomyoma of the Uterus

“…Only 94 cases have been described in the literature to date [ 4 , 5 ]. Our case describes the typical gross and microscopic findings consistent with cotyledonoid dissecting leiomyoma i.e., multiple, intramural septated nodules grossly resembling cotyledons, having an exophytic component in continuity with the intramural component [ 6 ], and microscopy showing nodules of smooth muscle tumor cells arranged in interlacing fascicles, focally dissecting through the myometrium with areas of edema and perinodular degeneration.…”

Cotyledonoid dissecting leiomyoma of the uterus: A rare case and literature review

“…However, fewer than 200 cases of CDL have been reported globally so far. CDL mostly manifests with symptoms similar to leiomyomas, including abdomeno‐pelvic masses and abnormal uterine bleeding 2 . Thus, the characteristics of CDL should be further explored.…”