Successful pregnancy outcome after laparoscopic-assisted excision of a bizarre leiomyoma: a case report

Akihiro Takeda,Masahiko Mori,Hiromi Nakamura,Sanae Imoto

doi:10.1186/1752-1947-5-344

Akihiro Takeda, Masahiko Mori + Show 2 more

Open Access

https://doi.org/10.1186/1752-1947-5-344

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Abstract

IntroductionBizarre leiomyoma is a rare leiomyoma variant that requires a precise histopathological evaluation. Especially when diagnosed in a younger woman, this tumor leads to challenging treatment issues involving fertility preservation. Owing to the low incidence of bizarre leiomyoma, there is insufficient evidence to support myomectomy alone as an appropriate management option. Also, the impact of bizarre leiomyoma on fertility is not well known.Case presentationA 30-year-old Japanese woman who had never given birth was referred to us because of a uterine tumor with an unusual diagnostic image and was treated by a gasless laparoscopic-assisted excision with a wound retractor. Owing to an unclear margin between her uterine tumor and myometrium, a concomitant excision of adjacent myometrial tissue was required to achieve the maximum resection of her tumor. The histopathological diagnosis was bizarre leiomyoma. Seven months later, she conceived spontaneously and her pregnancy course was uneventful. At 37 weeks of gestation, an elective cesarean section was performed. Although a slight omental adhesion was noted at the postexcisional scar, her uterine wall structure was well preserved and a recurrence of bizarre leiomyoma was not noted.ConclusionsA laparoscopic-assisted excision of bizarre leiomyoma is a feasible and minimally invasive conservative measure for a woman who wishes to preserve fertility.

Highlights

Bizarre leiomyoma is a rare leiomyoma variant that requires a precise histopathological evaluation
A slight omental adhesion was noted at the postexcisional scar, her uterine wall structure was well preserved and a recurrence of bizarre leiomyoma was not noted
Preoperative diagnostic image characteristics and minimally invasive conservative management of bizarre leiomyoma by a laparoscopicassisted excision that resulted in a successful pregnancy outcome in a woman who had never given birth are described

Summary

Introduction

Smooth muscle tumors of the uterus encompass a variety of benign and malignant neoplasms [1]. We informed our patient of the potential risk of hysterectomy if a conservative excision for a uterine tumor with an unusual appearance (indicating a possible malignancy) was unsuccessful She declined surgery at that time out of a fear of losing her fertility and chose instead to have her disease condition observed by ultrasonography at periodic check-ups. Owing to an unclear border between the uterine tumor and the myometrium, a concomitant excision of adjacent myometrial tissue was required to obtain maximum resection of the tumor During this procedure, direct palpation of the tumor and the surrounding myometrium by a surgeon’s index finger through the wound retractor [8] was able to reveal the excisional margin and minimize the damage to the normal uterine musculature (Figure 2C, arrow). The uterine wall structure was well preserved and a recurrence of bizarre leiomyoma was not noted (Figure 4)

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