Abstract
IntroductionRetroperitoneal leiomyomata are rare. They are either mistaken preoperatively for malignant retroperitoneal tumors or dealt with as cases of subserous leiomyomata that turn out intraoperatively to be huge retroperitoneal masses of unknown nature.Case presentationWe report the case of a 46-year-old nulligravid female patient of Middle Eastern ethnicity who presented to our university hospital with lower abdominal as well as pelvic pain along with a bloated sensation. She also reported noticing an unusual increase in her abdominal girth. These symptoms developed over the previous two months. Preoperative investigation by means of an ultrasound suggested a degenerated subserous huge uterine leiomyoma. An abdominal hysterectomy was planned. Intraoperatively, a normal sized uterus was found, the surface of which was studded with multiple variable sized pedunculated subserous leiomyomata. Another huge retroperitoneal soft to firm mass was found extending from her left pelvic wall to the level of her spleen, with no connections to her uterus. The mass was excised and a histopathological examination revealed a degenerated leiomyoma.ConclusionSome unusually located extra-uterine leiomyomata have been reported; retroperitoneal leiomyoma being among them. The origin of such tumors is still obscure; a parasitic origin as well as Müllerian cell rests or smooth muscle cells in the retroperitoneal vessels wall have been suggested. An 'iatrogenic' origin for such growths is also a possible theory. The origin of uncommonly located leiomyomata is an unexplored issue that merits more investigation.
Highlights
The huge degenerated leiomyoma previously delineated on sonography (Figure 3) turned out to be a retroperitoneal mass extending from the left side of her pelvis through the infundibulopelvic ligament upwards to the lower border of her spleen, with no connections with the leiomyomata-studded uterus
Uterine leiomyoma is the most common benign gynecological tumor affecting as many as 25% of women in the reproductive age group [6], and is present in about 80% of all hysterectomy specimens [7]
Of the reported retroperitoneal leiomyomata, 73% are located in the pelvis [9]
Summary
Thorough radiographic imaging of sonographically diagnosed leiomyomata is important, especially for those which are large in size or present in an uncommon location. Several theories have been postulated regarding the origin of retroperitoneal leiomyomata; the exact etiology is still an unexplored issue that merits more investigation. Author details 1Department of Obstetrics and Gynaecology, University of Alexandria, Egypt. Authors’ contributions AS wrote the manuscript and was directly involved in the patient care. NH was directly involved in the patient care and contributed to the review of the literature. HS was involved in the manuscript idea and drafting. TE provided general surgical input and critical reading of the manuscript. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests
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