Benign Smooth Muscle Tumors Research Articles

Familial multiple cutaneous leiomyomatosis in siblings: A rare case report

Piloleiomyoma, also known as Leiomyoma cutis, is a rare and benign smooth muscle tumour developing from the arrector pili muscle. It typically manifests as reddish-brown papules or nodules that are commonly present over the trunk and extremities, and are frequently associated with episodic pain. Familial multiple cutaneous leiomyomatosis have been reported in twins, siblings and multiple generations in a family which have a genetic predisposition and are found to be closely associated with uterine leiomyomas and renal cell carcinomas. In this article, we report a rare case of multiple cutaneous leiomyomatosis in siblings aged 54 years and 58 years respectively, diagnosed clinically and further confirmed with histopathological examination revealing typical features of cutaneous leiomyoma and positive immuno-histochemical testing for smooth muscle actin (SMA).

Erosion of calcified uterine leiomyoma into the urinary bladder: A case report

Introduction: Uterine leiomyomas are benign smooth muscle tumors that affect approximately 70–80% of women worldwide. Erosion of leiomyomas into surrounding tissues is a rare complication. We present a case of a postmenopausal female with uterine leiomyoma eroding into the urinary bladder. Case Report: A 55-year-old, postmenopausal female with history of uterine fibroids previously treated with uterine artery embolization presented with recurrent bladder stones, hematuria, and pelvic pain. Pelvic magnetic resonance imaging described a 4.3 cm heterogenous mass involving the ventral uterine fundus and bladder dome concerning for malignancy. She underwent robotic-assisted total laparoscopic hysterectomy, right salpingo-oophorectomy, left salpingectomy, and partial bladder cystectomy. Pathology was significant for benign calcified leiomyoma and benign calcifications within the bladder mucosa. Conclusion: Erosion of leiomyoma through the bladder mucosa is rare complication but should be considered in the differential diagnosis for patients presenting with hypercalciuria and recurrent bladder stones in the setting of uterine fibroids previously treated with uterine artery embolization.

S3521 A Rare Case of Duodenal Leiomyoma

Introduction: Only 1–5% of gastrointestinal neoplasms are found in the small intestine. Adenocarcinomas, lymphomas, and neuroendocrine tumors are the most common malignant tumors seen in the small intestine, while gastrointestinal stromal tumors, leiomyosarcomas, and leiomyomas are uncommon. The jejunum, ileum, and duodenum are the three most common locations for leiomyomas. We are presenting a rare case of a female with duodenal leiomyoma. Case Description/Methods: A 70-year-old female presented to the hospital with complaints of fatigue and weakness. Laboratory evaluation showed iron deficiency anemia with hemoglobin 7.5g/dl and hematocrit 25.4%. The patient reported an episode of black tarry stool about a week before the presentation. The patient received one packed red blood cell transfusion, and upper gastrointestinal endoscopy (EGD) was performed to evaluate anemia. EGD revealed non-erosive gastritis and gastric erosions without any current or recent bleeding stigmata. A single large pedunculated polyp was found in the duodenum's first portion, extending into the second portion of the duodenum(a). Biopsy from the polyp revealed submucosal leiomyoma without any evidence of dysplasia or malignancy(b). The next day, a colonoscopy showed significant diverticulosis and non-bleeding internal hemorrhoids. The patient remained hemodynamically stable and was discharged home the next day. The patient presented about a month later with iron deficiency anemia again. Repeat EGD and colonoscopy performed this time showed no obvious source of bleeding. We also conducted a pill cam study, which also came back negative. (Figure) Discussion: It is unusual for leiomyomas, which are benign smooth muscle tumors, to develop in the gastrointestinal tract. Males are more likely than females to be diagnosed with duodenal leiomyomas in the 6th and 7th decades of life. The origin and pathology of these tumors in the gastrointestinal tract remain a mystery. Leiomyomas of the duodenum seldom cause symptoms. When a duodenal tumor is larger, it might cause more severe symptoms, such as bleeding, nausea, vomiting, and weakness. In our patient described above, we believe the leiomyoma caused bleeding, as no other definitive source of bleeding was found even after a complete evaluation. The case describes a rare duodenal tumor with an unusual presentation.Figure 1.: a. EGD showing a large pedunculated polyp extending from the first portion to the second portion of the duodenum. b. H&E stain showing submucosal benign spindle cell proliferation. No atypia, pleomorphism or mitotic activity.

568 A Very Rare Presentation of Angioleiomyoma in the Oral Cavity

Abstract On the maxillofacial department, we receive many referrals of lumps or swellings in the oral cavity. The majority of these lesions are diagnosed clinically as fibroepithelial polyps or mucoceles, with excisional biopsy recommended for histopathological confirmation and removal. We report on the rare case of a 69-year-old male patient, who presented following referral from his General Dental Practitioner for a lump clinically representing a fibroepithelial polyp but was diagnosed histopathologically as an angioleiomyoma. Angioleiomyoma is a rare benign vascular smooth muscle tumour; it is very rarely seen in in the head and neck, with oral and maxillofacial lesions accounting for less than 0.5% of angioleiomyomas. We report this case to discuss clinical and histopathological diagnosis and raise awareness of it as potential differential diagnosis of lumps in the oral cavity.

A Novel Deep Learning-Based Mitosis Recognition Approach and Dataset for Uterine Leiomyosarcoma Histopathology.

Simple SummaryIn this paper, we present an artificial Intelligence (AI) based automatic detection of mitoses in Uterine Leiomyosarcoma. Mitotic count is one of the important biomarkers in the field of histopathology. A dataset is also made available to research community which consists of images having moitotically active region. These regions are labeled by a trained AI expert in coordination with a senior histopathologist. Preliminary results show AI as promising solution for detection of mitotically active regions mitotic region in Uterine leiomyosarcoma cases and can be used as a second opinion system.Uterine leiomyosarcoma (ULMS) is the most common sarcoma of the uterus, It is aggressive and has poor prognosis. Its diagnosis is sometimes challenging owing to its resemblance by benign smooth muscle neoplasms of the uterus. Pathologists diagnose and grade leiomyosarcoma based on three standard criteria (i.e., mitosis count, necrosis, and nuclear atypia). Among these, mitosis count is the most important and challenging biomarker. In general, pathologists use the traditional manual counting method for the detection and counting of mitosis. This procedure is very time-consuming, tedious, and subjective. To overcome these challenges, artificial intelligence (AI) based methods have been developed that automatically detect mitosis. In this paper, we propose a new ULMS dataset and an AI-based approach for mitosis detection. We collected our dataset from a local medical facility in collaboration with highly trained pathologists. Preprocessing and annotations are performed using standard procedures, and a deep learning-based method is applied to provide baseline accuracies. The experimental results showed 0.7462 precision, 0.8981 recall, and 0.8151 F1-score. For research and development, the code and dataset have been made publicly available.

Proteomic Profiling Identifies Co-Regulated Expression of Splicing Factors as a Characteristic Feature of Intravenous Leiomyomatosis.

Simple SummaryIntravenous leiomyomatosis is a rare form of smooth muscle tumour that has unique and distinct clinical features including growth within the uterine and pelvic veins. Here we use proteomics by mass spectrometry to show that this disease is distinct from uterine leiomyomas and other benign smooth muscle tumours due to the enrichment of components of the spliceosome machinery. In particular, we find that intravenous leiomyomatosis tumours harbour co-regulated expression of multiple splicing factors that are associated with biological processes including cell signalling. Our study demonstrates that intravenous leiomyomatosis is a distinct disease from other smooth muscle tumours and indicates a possible functional role for alternative splicing in disease initiation and progression.Intravenous leiomyomatosis (IVLM) is a rare benign smooth muscle tumour that is characterised by intravenous growth in the uterine and pelvic veins. Previous DNA copy number and transcriptomic studies have shown that IVLM harbors unique genomic and transcriptomic alterations when compared to uterine leiomyoma (uLM), which may account for their distinct clinical behaviour. Here we undertake the first comparative proteomic analysis of IVLM and other smooth muscle tumours (comprising uLM, soft tissue leiomyoma and benign metastasizing leiomyoma) utilising data-independent acquisition mass spectrometry. We show that, at the protein level, IVLM is defined by the unique co-regulated expression of splicing factors. In particular, IVLM is enriched in two clusters composed of co-regulated proteins from the hnRNP, LSm, SR and Sm classes of the spliceosome complex. One of these clusters (Cluster 3) is associated with key biological processes including nascent protein translocation and cell signalling by small GTPases. Taken together, our study provides evidence of co-regulated expression of splicing factors in IVLM compared to other smooth muscle tumours, which suggests a possible role for alternative splicing in the pathogenesis of IVLM.

HISTOMORPHOLOGICAL SPECTRUM OF UTERINE LEIOMYOMA VARIANTS – A RETROSPECTIVE STUDY IN TERTIARY CARE HOSPITAL

To study the histomorphological spectrum of uterine leiomyoma variants. This study is done over a period of three year (May 2019 to May 2022) in the Department of Pathology, LNMC, Bhopal. Total of 316 hysterectomy and 14 myomectomy specimens were studied. Specimens were fixed in formalin and paraffin embedded. H&E stained tissue sections were studied. In the study we performed retrospective analysis of hysterectomy and myomectomy specimen and 330 cases of leiomyoma were evaluated. Among 330 cases, 316(95.75%) were hysterectomy specimen for varying indication and 14(4.24%) were myomectomy specimen. Histologically the usual leiomyomas was comprising of 164(49.69%) cases followed by hyalinised leiomyoma 70(21.21%), myxoid leiomyoma 15(4.54%), hydropic change 12(3.63%), cellular 11(3.33%), lipoleiomyoma 10(3.03%), calcification 10(3.03%), infarct type necrosis 10(3.03%), mitotically active 8(2.42%), symplastic 7 (2.12%), schwanonian 6(1.81%), epithelioid 3(0.90%), dissecting leiomyoma 2 (0.60%) and stromal metaplasia (osseous and cartilaginous) 2(0.60%). Leiomyoma is the commonest benign smooth muscle tumor of the uterus with a number of histological variants. In this study conventional leiomyoma being the commonest variant followed by hyalinized leiomyoma, myxoid leiomyoma, hydropic leiomyoma and lipoleiomyoma. It is important to categorise various types of leiomyoma on histology to avoid misdiagnosis.

AB140. SOH22ABS052. Back to basics: a complex case of a multiple fibroid uterus: a case report

Background: Uterine fibroids (leiomyomas) are benign smooth muscle tumours of the uterus. They are the commonest benign pelvic tumour in females. They occur in nearly 50% of women over 35 years of age, with an increased prevalence during the reproductive phase due to hormone-stimulated growth. 80% of African and approximately 70% of Caucasian women will have fibroids by the age of 50. There are both medical and surgical options for the management of uterine fibroids. We report a case of a 49-year-old Caucasian female, parity zero (P0), with a multiple fibroid uterus, the largest fibroid measuring 11 cm. She had opted against medical management (including GnRH analogues) and due to her medical history, she was unable to have uterine artery embolisation. She was admitted for elective total abdominal hysterectomy and bilateral salpingo-oophorectomy. This procedure proved to be difficult and complex due to the multiple large fibroids. Multiple fibroid enucleations were performed to gain access to the uterus, vagina, and cervix. We discuss the complexity and uniqueness of this surgical case and the current management options for uterine fibroids.

A rare case report of piloleiomyomas

Leiomyoma is a rare benign tumor of smooth muscle. In the word leiomyomas, “Leio” means “smooth”, “myo” means ‘muscle’, and “oma” means ‘tumor’. It may arise from smooth muscles of the skin, uterus, bladder, urethra. Depending upon the origin of skin smooth muscles cutaneous leiomyomas are of three main types: 1. Piloleiomyoma or leiomyoma cutis or pilar leiomyoma derived from arrector pili muscle; 2. Genital leiomyoma or dartoic myoma is derived from smooth muscle of the scrotum, vulva, and areola of the nipple, and 3. Angioleiomyoma is derived from the media of blood vessels. We report one such rare case of multiple piloleiomyomas.

Role of the Immunohistochemical ZEB1 Expression in Uterine Mesenchymal Neoplasms.

The distinction of mesenchymal tumors of the uterus is a frequent diagnostic challenge in gynecologic pathology. Especially, distinguishing low-grade endometrial stromal sarcoma (ESS) from leiomyoma or distinguishing low-grade ESS from high-grade ESS can be difficult. Epithelial-mesenchymal transition (EMT) is a physiological and pathological process in which epithelial cells lose their morphological features, become elongated and acquire mesenchymal traits. The signaling pathway of Zinc finger E-box binding homeobox 1 (ZEB1) is one of the most significant pathways involved in the EMT process and it has a crucial role in cancer progression, metastasis, and therapy resistance. We studied a series of 69 uterine mesenchymal neoplasms including 18 endometrial stromal sarcomas (10 cases of low grade and 8 cases of high grade endometrial stromal sarcomas), 26 leiomyosarcomas (8 cases of grade 1 and 19 cases of grade 2-3 leiomyosarcomas), 15 leiomyomas, and 10 rhabdomyosarcomas, using an antibody ZEB1. We graded the leiomyosarcomas depending on the FNCLCC grading system. It was observed that leiomyosarcoma was more intensely stained with ZEB1 than leiomyoma (P < 0.001) and high-grade ESS was significantly more intensely stained with ZEB1 protein than low-grade ESS (P < 0.004). It also was observed that high-grade leiomyosarcoma was significantly more intensely stained with ZEB1 protein than low-grade leiomyosarcoma (P < 0.000). Our data suggest that Zeb1 can be used to differentiate high-grade sarcomas from their low-grade counterparts as well as benign and malignant smooth muscle tumors of the uterus.

Status of Vitamin D in Women with Uterine Fibroid and Impact of Vitamin D Supplementation

Uterine fibroids, also known as leiomyomas, are benign smooth muscle tumors of the uterus. The exact cause of uterine fibroids is indistinct. However, fibroids appear to be partly determined by hormone levels. There is a high prevalence of Vitamin D deficiency for uterine fibroids. Vitamin D from food or from skin synthesis by sunshine becomes biologically inactive. It is activated by two protein enzyme hydroxylation steps. The first in the liver and the second in the kidney. As Vitamin D can be synthesized, it is considered a prohormone. Vitamin D is taken to the liver where it is transformed into 25[OH] D.

A RARE CASE OF RETROPERITONEAL LEIOMYOMA – A HISTOPATHOLOGICAL CASE REPORT

Uterine Leiomyoma is one of the most common benign tumor in women in which hysterectomy is done. Retroperitoneal leiomyomas are rare entity of benign smooth muscle tumors which may be presented as single or multiple small peritoneal nodules. Because of its rarity and non-specific presentation, the pre-operative diagnosis might be challenging. These neoplasms shows same morphological and microscopic features similar to uterine leiomyoma. Here we present a case of retroperitoneal leiomyoma in a 40 years old woman suspected to be a malignant tumour of unknown nature. After post-surgical resection the retroperitoneal mass was sent to the Department of Pathology, RIMS Ranchi for histopathological diagnosis. After histopathological examination the case was confirmed as leiomyoma but the final diagnosis of retroperitoneal fibroids can be obtained intra-operatively and after histopathological examination. We report the case from a histopathological perspective with a brief review of relevant literature. Retroperitoneal fibroids are rare neoplasm and surgical removal of the tumour is the main treatment.

A case report of atypical uterine leiomyoma

Abstract Introduction: Atypical uterine leiomyoma (ALM) shows benign behavior and does not require adjuvant therapy. As the distinction between uterine leiomyoma, ALM, and leiomyosarcoma is only possible through pathology, it is almost impossible to diagnose ALM before surgery. Patient concerns: A 34-year-old multigravida woman who had undergone myomectomy for leiomyoma ten years earlier presented with fibroids that had gradually increased in size. Diagnoses: An ultrasound scan and abdominal and pelvic computed tomography revealed large myomas. The postoperative pathologic findings confirmed the diagnosis of ALM. The Ki-67 proliferation index was 15%. Interventions: We performed laparoscopic myomectomy. Outcomes: The patient recovered well after the surgery. The patient has undergone ultrasound follow-up every six months after surgery and has been doing well for three years without any recurrence. Conclusion: The combination of clinical features, imaging, pathological findings, and tumor suppressor gene Ki-67 expression may be of great value in the assessment of benign, atypical, and malignant uterine smooth muscle tumors. There are still no precise methods to differentiate them before surgery, and pathology remains the gold standard for diagnosis. Periodic monitoring is recommended until menopause, although the recommended interval remains controversial.

Leiomyoma of the Inferior Vena Cava

Leiomyomas are benign smooth muscle tumors that can develop at any site where smooth muscle is present. The leiomyoma in the inferior vena cava is a rarely observed pathology. We report the case of a 50-year-old patient, an abdomino-pelvic CT scan was performed which allowed to specify the retroperitoneal location of the mass, lateralized on the right, at the expense of the inferior vena cava (IVC), with a benign appearance of the IVC, Anatomopathological examination is in favor of a leiomyoma of the IVC.

S1826 Case Series: Successful Endoscopic Resection of Colorectal Leiomyomas

Introduction: Colorectal leiomyomas are relatively uncommon, accounting for 3% of all gastrointestinal leiomyomas. Leiomyomas are often identified incidentally; however, some patients may present with symptoms of abdominal pain or rectal bleeding. Surgical resection was historically the standard of care for removal of these smooth muscle tumors, particularly for tumors larger than 2 cm. However, with ongoing advances in endoscopic techniques, endoscopic polypectomies have fallen into favor for management of these submucosal lesions as it is less invasive and less costly. We present two cases of colorectal leiomyomas that were successfully managed endoscopically without surgical intervention. Case Description/Methods: A 69-year-old male presented to the gastroenterology clinic for colorectal cancer screening. He endorsed 3 to 4 bouts of watery diarrhea daily and 15-pound unintentional weight loss over one year duration. A colonoscopy was subsequently performed revealing a 1cm pedunculated polyp in the descending colon [See Figure 1]. The base of the polyp was injected with 4mL of 1:100,000 epinephrine with adequate lift. A hot snare polypectomy was performed using standard ERBE settings. Pathology revealed a submucosal benign mesenchymal neoplasm. Immunohistochemical staining was strongly positive for Smooth Muscle Actin (SMA) and Desmin, solidifying the diagnosis of leiomyoma. A 41-year-old male was seen by the gastroenterology division on the inpatient service for evaluation of rectal bleeding. A colonoscopy was performed revealing a 4mm sessile polyp in the rectum that was completely removed via cold biopsy forceps [See Figure 2]. Pathology revealed a microscopic submucosal spindle cell lesion. Immunohistochemical staining was positive for SMA with no expression of CD-117 and DOG-1, supporting the diagnosis of leiomyoma. Discussion: The optimal therapeutic approach for large colorectal leiomyomas remains controversial but usually depends on the location, size, and direction of tumor growth. Our patients were managed successfully with endoscopic resection alone. Both patients had a surveillance colonoscopy that revealed no residual tumor or recurrence of tumor growth. These benign smooth muscle tumors have excellent prognosis and typically do not recur after removal. These cases support the notion that leiomyomas can often be removed endoscopically with limited morbidity and have excellent outcomes.Figure 1.: 1 cm pedunculated polyp in descending colon (case 1).Figure 2.: 4 mm sessile polyp in rectum (case 2).

Cutaneous Leiomyoma: A Clinical Study of 152 Patients

Background: Cutaneous leiomyoma (CL) is a benign smooth muscle tumour included in painful skin tumours. Multiple CLs are cutaneous markers of hereditary leiomyomatosis and renal cell cancer (HLRCC). Objectives: To retrospectively review our series of patients with CLs to analyse their clinical features and the association with HLRCC. Methods: Cases coded as CL in the database of the pathology department between 2004 and 2019 were included in the study. Medical records were retrospectively reviewed to obtain the following data: age, sex, location, number of lesions, diameter, evolution time at diagnosis, suspected clinical diagnosis, tenderness, status of resection margins, development of recurrence, follow-up time, and association with HLRCC. Results: 152 patients had CLs, 89 women and 63 men, mean age 56.26, SD 16.030 years. Subtypes were piloleiomyoma in 62 patients, angioleiomyoma in 80, and genital leiomyoma in 10. All of our 11 patients with multiple lesions corresponded to piloleiomyomas, and HLRCC was confirmed in 8 of them (73%). Patients with HLRCC were younger than patients with piloleiomyomas without HLRCC (34.88 vs. 56.17 years, p = 0.009). Vascular and genital leiomyomyomas were solitary and were not associated with HLRCC. Conclusion: In patients with multiple piloleiomyomas HLRCC must be ruled out as it is confirmed in a high proportion of cases. The probability of fumarate hydratase mutation is greater in multiple piloleiomyomas involving both the trunk and upper extremities in the same patient.

Assessment of Management and Life Style Modification in Uterine Fibroid Patient's

Uterine fibroids, also known as uterine Leiomyomas or fibroids, are benign smooth muscle tumours of the uterus that can be seen in women of child bearing age. Women in their first trimester of pregnancy suffer no symptoms, but others may experience painful or heavy periods. The presence of fibroids might occasionally make it more difficult to become pregnant; however, this is uncommon. Approximately 20 percent to 80 percent of women develop fibroids by the time they reach the age of 50. If there are no symptoms, it is typically not necessary to seek medical attention. Paracetamol (acetaminophen) and other nonsteroidal anti-inflammatory medicines (NSAIDs) may be used to relieve pain and bleeding, while ibuprofen and other NSAIDs may be used to relieve pain and bleeding. It is possible that women who have heavy periods will require iron supplements. The use of medications from the gonadotropin-releasing hormone agonist family may help to reduce the growth of fibroids, but they are both expensive and associated with negative side effects. Patient counselling and education will aid in lowering the risk to patients and slowing the progression of the study. The work done to determine the causes of anaemia will aid in increasing knowledge about anaemia, including dietary modifications, and decreasing the progression of the study by providing patient counselling and education. The findings of a six month study of 75 cases of fibroids discovered in 362 samples revealed that uterine fibroids are the most common malignancy in women of reproductive age. Uterine fibroids are not only found in women of null parity; they can also be found in women with multiple pregnancies. On the contrary, the prevalence of anaemia, heavy bleeding with clots, and metrorrhagia in fibroids is rather high, which has an impact on psychological state as a result of the stigma associated with the sickness status, and which interferes with everyday activities.

Intra-articular leiomyoma of the knee mimicking a ganglion cyst in a child: A case report and review of literature.

Introduction and importanceAngioleiomyoma is a rare benign soft tissue tumor of smooth muscle getting its origin from the muscular layer of vessel walls. The localized type of leiomyoma occurs on the skin, deep soft tissues, in the genitourinary, gastrointestinal, and respiratory tracts.Case presentationWe report a case of a 16-year-old patient who presented with an intra-articular leiomyoma developed in the anterior cruciate ligament and treated with arthroscopy.Clinical discussionAngioleiomyoma can occur anywhere in the body and is most often seen in the extremities, particularly the lower limbs, but is very rare in the knee joint. Angioleiomyoma should be included in the differential diagnosis of nodular lesions mimicking loose body, such as lipomas, inclusion cysts, ganglion, pigmented villonodular synovitis (PVNS), fibroma, nodular synovitis, hemangioma, synovial sarcoma, myopericytoma, leiomyosarcomas, glomus tumor.ConclusionAngioleiomyoma related to the cruciate ligaments of the knee should be considered in the differential diagnosis of a painful knee especially when associated with a decreased of range of motion of knee. The arthroscopic debridement should be considered the treatment of choice in order to reliably restore active ROM.

Telomere shortening and expression of TRF1 and TRF2 in uterine leiomyoma.

Uterine leiomyoma is a benign smooth muscle tumor of the uterus that can exhibit histopathological traits that mimic malignancy. Telomere shortening is an early event in tumorigenesis and telomerase activation facilitates tumor progression later in the course of carcinogenesis. Telomeric repeat‑binding factor (TRF)1 and TRF2 protect telomeres, and their gene expression levels are dysregulated in various cancer types. However, the roles of telomeres and telomere protection proteins in uterine leiomyoma remain largely unknown. In this study, telomere length and the mRNA levels of various telomere‑related genes in normal tissues and leiomyoma were determined, and their relationships were evaluated. Uterine leiomyoma and normal myometrium were surgically obtained from 18 and 13patients, respectively. Telomere length and gene expression were determined by Southern blot analysis and reverse transcription‑quantitative PCR, respectively. In matched samples, telomeres were consistently shorter in leiomyoma tissue than in adjacent normal tissue. TRF1, TRF2, PIN2‑interacting telomerase inhibitor1(PINX1), and telomerase RNA component were expressed at comparable levels in both leiomyoma and normal tissues. None of these genes were associated with telomere length in leiomyoma. All tested tissues were negative for telomerase reverse transcriptase, which encodes the catalytic component of telomerase, indicating that cells in uterine leiomyoma were not immortalized. In summary, telomere erosion, which reflects active proliferation during tumor evolution, was evident in uterine leiomyoma. Steady‑state expression of TRF1, TRF2 and PINX1 may be important for maintenance of telomere integrity in leiomyoma, where telomere length is shortened.

Leiomyoma of levator ani muscle

Epithelioid leiomyomas of the vagina are extremely rare benign smooth muscle tumors. Leiomyomas are located in uterus in 70%; however, paravaginal leiomyomas are rare, which frequency is 0.1% in adults women. They can be asymptomatic, but if they are, may cause signs of compression, dyspareunia, urinary disorders,… The diagnosis is made by histologic and immunohistochemical examination, helped by imaging tests such as RMN and ultrasound. The first treatment option is the resection by enucleation. Search of information was carried out in the PubMed/Medline, Cochrane, SciELO databases and references from articles in journals and recent published texts. This is a case report of a 29-years-old female who is derived to Gynecologic Emergencies because of a Bartholinitis refractory to antibiotic treatment. The gynecological exploration reports a vaginal mass which extends to left paravaginal space. The biopsy of this mass suggests the diagnosis of leiomyoma. MRI study reports a 49mm mass in left ischiorectal space which seems to depend on puborectal muscle. The resection is made by enucleation, with a histopathological examination that confirms the diagnostic suspicion.