Rare concomitant myxoid and cystic degeneration of uterine leiomyoma: Case report

Igor Samardjiski,Gordana Petrushevska,Irena Todorovska,Slagjana Simeonova-Krstevska,Maja Pejkovska-Ilieva,Vesna Livrinova,Sasho Dimitrovski,Iva Paneva,Katerina Nikoloska

doi:10.5937/scriptamed52-31448

Abstract

The uterine leiomyomas are monoclonal tumours of myometrial smooth muscle cells that are oestrogen dependent. A 43-year-old patient was referred by her gynaecologist under a suspected diagnosis of ovarian tumour. She complained of prolonged and profuse, regular menstrual bleeding that leaded to anaemia. The ultrasound examination showed a complex tumour mass with dimensions 68 x 85 mm, with several cystic formations fulfilled with clear fluid, which protrudes from the posterior wall of the uterus. Therefore, the diagnosis of leiomyoma with a cystic degeneration was considered preoperatively. In the case of cystic degeneration of the myoma, the ultrasound shows a combination of cystic and solid components with irregular shape and variable echogenicity. The ovarian malignancy should be ruled out in the presence of a large cystic mass with irregular septa and solid nodular parts filling the small pelvis. Ultrasound characteristics of degenerative myomas should always be considered, so as not to replace it with an ovarian mass, especially if it is subserosal and on the loop.

Highlights

The uterine leiomyoma is the most common pelvic tumour in the female population
The exact incidence is difficult to be determine as all the studies are either based on symptomatic cases or histopathological evaluation of the preparations after hysterectomy
The ultrasound examination showed a complex tumour mass with dimensions 68 x 85 mm, with several cystic formations fulfilled with clear fluid, which protruded from the posterior wall of the uterus (Figure 1 and 2)

Summary

Introduction

The uterine leiomyoma is the most common pelvic tumour in the female population. The exact incidence is difficult to be determine as all the studies are either based on symptomatic cases or histopathological evaluation of the preparations after hysterectomy. The ultrasound examination showed a complex tumour mass with dimensions 68 x 85 mm, with several cystic formations fulfilled with clear fluid, which protruded from the posterior wall of the uterus (Figure 1 and 2). The tumour mass was continuous with the rest of the myometrium on the posterior wall of the uterus, indicating uterine origin (Figure 3). The left ovary was displaced cranially and posteriorly from the tumour mass, and with neat morphology on ultrasound. The patient underwent a laparotomy and large leiomyoma was found originating from the left part of the posterior uterine wall. Both ovaries were with a neat morphology. The histopathological analysis showed a leiomyoma with an extensive area of myxoid degeneration and cystic spaces. Staining for CD34, CD10 and CD31 was negative corresponding to a cystic degenerative leiomyoma (Figure 5)

Discussion

Findings

Conclusion