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Cotyledonoid dissecting leiomyoma of the uterus
IMAGES IN REPRODUCTIVE MEDICINE Cotyledonoid dissecting leiomyoma of the uterus Francisco Raga, M.D., Ph.D., Magda Sanz-Cort es, Ph.D., Eva Maria Casa~ n, M.D., Octavio Burgues, M.D., and Fernando Bonilla-Musoles, M.D., Ph.D. Departamento de Obstetricia y Ginecologia, Hospital Clinico Universitario de Valencia, Valencia, Spain
We describe a cotyledonoid dissecting leiomyoma in a 33-year-old nulliparous woman treated by laparoscopy. (Fertil Steril 2009;91:1269–70. 2009 by American Society for Reproductive Medicine.) Key Words: Cotyledonoid dissecting leiomyoma
A 33-year-old nulliparous woman presented with a history of menorrhagia and abdominal pain. Three-dimensional ultrasound and magnetic resonance imaging (MRI) showed
a 6-cm, irregular mass in the right lateral aspect of the uterus (Figs. 1 and 2). Laparoscopy revealed a multinodular ‘‘grapelike’’ mass protruding from the uterus and extending into the
FIGURE 1 Transvaginal three-dimensional ultrasound showed a 6-cm, irregular mass in the right lateral aspect of the uterus.
Raga. Cotyledonoid leiomyoma. Fertil Steril 2009.
Received February 18, 2008; revised May 21, 2008; accepted August 26, 2008; published online February 6, 2009. F.R. has nothing to disclose. M.S-C. has nothing to disclose. E.M.C. has nothing to disclose. O.B. has nothing to disclose. F.B-M. has nothing to disclose. Reprint requests: Francisco Raga, M.D., Ph.D., Departamento de Obstetricia y Ginecologıa, Hospital Clınico Universitario, Valencia, Spain (FAX: 34-963515477; E-mail: [email protected]).
0015-0282/09/$36.00 doi:10.1016/j.fertnstert.2008.08.131
broad ligament. The tumor consisted of innumerable fragments of solid reddish nodules connected by thin fibrous tissue (Fig. 3). The patient underwent tumor resection, and the frozen sections showed a histologically benign tumor. Microscopically, the tumor compromised interlacing fascicles of uniform smooth muscle cells with no atypia (Fig. 4).
Fertility and Sterility Vol. 91, No. 4, April 2009 Copyright ª2009 American Society for Reproductive Medicine, Published by Elsevier Inc.
1269
FIGURE 2
FIGURE 4
Pelvic MRI shows a heterogeneous mass lesion (arrow) in the right lateral aspect of the uterus.
The tumor is composed of nodules of smooth muscle fascicles by hydropic connective tissue containing congested vessels (stain: hematoxylin and eosin; magnification: 40).
Raga. Cotyledonoid leiomyoma. Fertil Steril 2009.
Raga. Cotyledonoid leiomyoma. Fertil Steril 2009.
FIGURE 3 Gross appearance of the resected mass shows innumerable congested nodules.
Cotylenoid dissecting leiomyoma or Sternberg tumor is an extremely rare variant of uterine leiomyoma (1–3). These tumors have been described as occurring in women of reproductive age (1, 2). This rare type of leiomyoma features extensive hydropic degeneration, resulting in a solid cystic appearance (1). Therefore, it is difficult to differentiate this leiomyoma from a cystic degenerating myoma using diagnostic images (4). It is important to recognize this type of tumor because its bizarre macroscopic shape may be confused with malignant neoplasm (1, 3).
REFERENCES
Raga. Cotyledonoid leiomyoma. Fertil Steril 2009.
1270
Raga et al.
Cotyledonoid leiomyoma
1. Weissferdt A, Maheshwari MB, Downey GP, Rollason TP, Ganesan R. Cotylenoid dissecting leiomyoma of the uterus: a case report. Diagn Pathol 2007;2:18–21. 2. Gurbuz A, Karateke A, Kabaca C, Arik H, Bilgic R. A case of cotylenoid leiomyoma and review of the literature. Int J Gynecol Cancer 2005;15:1218–21. 3. Cheuk W, Chan JK, Liu JY. Cotylenoid leiomyoma: a benign tumour with alarming gross appearance. Arch Pathol lab Med 2002;126:210–3. 4. Protopapas A, Milingos S, Markaki S, loutradis D, Haidopoulos D, Sotiropoulou M, et al. Cystic uterine tumors. Gynecol Obstet Invest 2008;65:275–80.
Vol. 91, No. 4, April 2009
We describe a cotyledonoid dissecting leiomyoma in a 33-year-old nulliparous woman treated by laparoscopy. (Fertil Steril 2009;91:1269–70. 2009 by American Society for Reproductive Medicine.) Key Words: Cotyledonoid dissecting leiomyoma
A 33-year-old nulliparous woman presented with a history of menorrhagia and abdominal pain. Three-dimensional ultrasound and magnetic resonance imaging (MRI) showed
a 6-cm, irregular mass in the right lateral aspect of the uterus (Figs. 1 and 2). Laparoscopy revealed a multinodular ‘‘grapelike’’ mass protruding from the uterus and extending into the
FIGURE 1 Transvaginal three-dimensional ultrasound showed a 6-cm, irregular mass in the right lateral aspect of the uterus.
Raga. Cotyledonoid leiomyoma. Fertil Steril 2009.
Received February 18, 2008; revised May 21, 2008; accepted August 26, 2008; published online February 6, 2009. F.R. has nothing to disclose. M.S-C. has nothing to disclose. E.M.C. has nothing to disclose. O.B. has nothing to disclose. F.B-M. has nothing to disclose. Reprint requests: Francisco Raga, M.D., Ph.D., Departamento de Obstetricia y Ginecologıa, Hospital Clınico Universitario, Valencia, Spain (FAX: 34-963515477; E-mail: [email protected]).
0015-0282/09/$36.00 doi:10.1016/j.fertnstert.2008.08.131
broad ligament. The tumor consisted of innumerable fragments of solid reddish nodules connected by thin fibrous tissue (Fig. 3). The patient underwent tumor resection, and the frozen sections showed a histologically benign tumor. Microscopically, the tumor compromised interlacing fascicles of uniform smooth muscle cells with no atypia (Fig. 4).
Fertility and Sterility Vol. 91, No. 4, April 2009 Copyright ª2009 American Society for Reproductive Medicine, Published by Elsevier Inc.
1269
FIGURE 2
FIGURE 4
Pelvic MRI shows a heterogeneous mass lesion (arrow) in the right lateral aspect of the uterus.
The tumor is composed of nodules of smooth muscle fascicles by hydropic connective tissue containing congested vessels (stain: hematoxylin and eosin; magnification: 40).
Raga. Cotyledonoid leiomyoma. Fertil Steril 2009.
Raga. Cotyledonoid leiomyoma. Fertil Steril 2009.
FIGURE 3 Gross appearance of the resected mass shows innumerable congested nodules.
Cotylenoid dissecting leiomyoma or Sternberg tumor is an extremely rare variant of uterine leiomyoma (1–3). These tumors have been described as occurring in women of reproductive age (1, 2). This rare type of leiomyoma features extensive hydropic degeneration, resulting in a solid cystic appearance (1). Therefore, it is difficult to differentiate this leiomyoma from a cystic degenerating myoma using diagnostic images (4). It is important to recognize this type of tumor because its bizarre macroscopic shape may be confused with malignant neoplasm (1, 3).
REFERENCES
Raga. Cotyledonoid leiomyoma. Fertil Steril 2009.
1270
Raga et al.
Cotyledonoid leiomyoma
1. Weissferdt A, Maheshwari MB, Downey GP, Rollason TP, Ganesan R. Cotylenoid dissecting leiomyoma of the uterus: a case report. Diagn Pathol 2007;2:18–21. 2. Gurbuz A, Karateke A, Kabaca C, Arik H, Bilgic R. A case of cotylenoid leiomyoma and review of the literature. Int J Gynecol Cancer 2005;15:1218–21. 3. Cheuk W, Chan JK, Liu JY. Cotylenoid leiomyoma: a benign tumour with alarming gross appearance. Arch Pathol lab Med 2002;126:210–3. 4. Protopapas A, Milingos S, Markaki S, loutradis D, Haidopoulos D, Sotiropoulou M, et al. Cystic uterine tumors. Gynecol Obstet Invest 2008;65:275–80.
Vol. 91, No. 4, April 2009