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Indian Journal of Cancer, Vol. 48, No. 1, January-March, 2011, pp. 120-121 Letter to Editor An unusual variant of leiomyoma masquerading peroperatively as sarcoma S Aggarwal, VK Arora Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi - 110 095, India Correspondence Address: Code Number: cn11025
Sir, A 52-year-old woman para 3, with 3 live births presented with menorrhagia and uterine prolapse in the gynecology outpatient department. She had 3 o uterovaginal prolapse with cystocele and enterocele. On ultrasonography, a large fibroid of uterus was seen. Total abdominal hysterectomy with left salpingo-opherectomy was done. Per-operatively, a large, exophytic, multinodular 10×10 cm, red-brown tumor having multiple bulbous processes was seen. The tumor extended into the peritoneal cavity and left broad ligament and was attached with a pedicle to the uterus in the region of the left cornua [Figure - 1]a. The exophytic mass was continuous with an intramural component dissecting the surrounding myometrium. Because of this alarming appearance of the tumor, the possibility of sarcoma was considered during surgery. On microscopic examination, bulbous processes were found to be composed of disorganized fascicles of benign smooth muscle fibers arranged in interlacing fascicles or swirls. There was focal hydropic degeneration [Figure - 1]b. Significant nuclear atypia, mitotic activity, and coagulative tumor necrosis were conspicuous by their absence. No intravascular involvement was present. The patient was apparently healthy 6 months post surgery. Morphological diagnosis of cotyledonoid leiomyoma was made. Leiomyoma are benign smooth muscle proliferations of the uterus, frequently found in women in the age range of 30-45 years. These are the most common types of abnormal pelvic growth in women, affecting mostly the body of the uterus, but may also be found in the cervix, broad ligament, and, rarely, the ovary. Estrogens and estrogen receptors play a major role in the pathogenesis of leiomyoma. In the uterus, these tumors may be intramural, submucosal and subserosal. Grossly, the cut surface is firm and rubbery, and shows a whorled, spiral pattern of fibers. Cotyledonoid dissecting leiomyoma is a rare variant. To date, only 11 cases have been reported in the English literature. [1],[2],[3],[4],[5],[6],[7] Cotyledonoid leiomyoma or "grapelike leiomyoma" or "Sternberg tumor" is a rare variant of benign uterine leiomyoma characterized by extrauterine bulbous growth having continuity with a dissecting myometrial component. The tumor grossly resembles placenta. The median age of patients at presentation is 40 years (range, 23-65 years). Because of lack of familiarity with the alarming fungating appearance of cotyledonoid leiomyoma, the large size of the tumor and the apparent widespread infiltrative growth with frequent extension into the pelvic cavity and broad ligament, and even into the retroperitoneal space, grossly mimics malignancy. Increased awareness of this grossly alarming variant of uterine leiomyoma can help avoid over-treatment at the time of surgery. References
Copyright 2011 - Indian Journal of Cancer The following images related to this document are available:Photo images[cn11025f1.jpg] |
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