Leiomyoma Presenting Research Articles

S5069 A Rare Case of Gastric Leiomyoma Presenting With Acute Abdominal Pain

S5069 A Rare Case of Gastric Leiomyoma Presenting With Acute Abdominal Pain

Pulmonary benign metastasizing leiomyoma presenting as acute hypoxemic respiratory failure: a case report

Pulmonary benign metastasizing leiomyoma is an uncommon condition, predominantly affecting women of childbearing age with a history of uterine smooth muscle tumors and uterine leiomyoma surgery for uterine leiomyoma. The progression of PBML is often unpredictable and depends on the extent of lung involvement. Generally, most patients remain asymptomatic, but a minority may experience coughing, wheezing, or shortness of breath, which are frequently misdiagnosed as pneumonia. consequently, this presents significant challenges in both treatment and nursing care before diagnosis. This paper reports the case of a 35-year-old woman primarily diagnosed with acute hypoxic respiratory failure who was transferred from the emergency room to the intensive care unit. The initial computed tomography scan of the patient’s lungs indicated diffuse interstitial pneumonia, but the sequencing of the alveolar lavage fluid pathogen macro did not detect any bacteria, fungi, or viruses. Moreover, the patient remained in a persistent hypoxic state before the definitive diagnosis. Therefore, our focus was on maintaining the airway patency of the patient, using prone ventilation, inhaling nitric oxide, monitoring electrical impedance tomography, and preventing ventilator-associated pneumonia to improve oxygenation, while awaiting immunohistochemical staining of the patient’s biopsied lung tissue. This would help us clarify the diagnosis and treat it based on etiology. After meticulous treatment and nursing care, the patient was weaned off the ventilator after 26 days and transferred to the respiratory ward after 40 days. This case study may serve as a reference for clinical practice and assist patients suffering from PBML.

A rare enterouterine fistula between uterine leiomyoma and sigmoid colon in a nulliparous woman: a case report

BackgroundThe commonest benign neoplasm encountered in women of reproductive age group is uterine leiomyoma which usually presents with abnormal uterine bleeding, chronic pelvic pain, urinary disturbances, urinary retention, constipation, and dyspareunia. Uterine leiomyoma presenting with bowel fistulization is a rare presentation. To our knowledge and based on a thorough literature search, no previous reports of uterine leiomyoma showing spontaneous fistulous communication with the sigmoid colon have been reported.Case presentationA nulliparous woman in her early 30s presented with complaints of lower abdominal pain, abdominal fullness, pus discharge from the vagina, and difficulty in respiration. On contrast-enhanced computed tomography (CECT), a large heterogeneously enhancing mass was seen in the rectouterine space showing air-fluid levels, with a fistulous communication with the adjacent sigmoid colon. Histopathological examination proved the lesion to be a uterine leiomyoma.ConclusionThe chance of fistulization with the bowel should be considered whenever a uterine mass with an air-fluid level is encountered.

Histological changes of endocervical polypoid lesions in women at reproductive age

Abstract Background: Endocervical polyps (ECP) are fragile benign protrusions commonly affecting 2%–5% of women during the reproductive age. Aim: This study aimed to identify the histopathological changes of clinically identified endocervical polypoid lesions during the reproductive age to detect any premalignant or malignant transformation if present. The objective is to assist the clinicians to decide whether the cervical polyps should be excised or not. Materials and Methods: Sixty specimens of the resected cervical polyps were obtained from Al-Salaam Teaching Hospital in Mosul city during the period from June 2021 to February 2022, women diagnosed to have cervical polyps on per speculum examination were given a time to be operated on with exclusion of pregnant, postmenopausal women, those on hormone replacement therapy, and those below 20 years. After polypectomy, fixation of biopsies in 10% buffered formalin was done followed by processing and staining with hematoxylin and eosin for histological examination. Chi-square test was used for interpretation of the histological findings. Results: The study revealed that 52% of the enrolled women were in the range of 40–49 years of age. Squamous metaplasia and benign microglandular hyperplasia were detected equally in 25% of the study group. Nabothian cyst was observed in 8%, whereas leiomyoma presenting as cervical polyp in 6%. Fortunately, no malignant changes were reported in the examined 60 cases and the only serious lesion was cervical intraepithelial neoplasia (CIN) observed in 2% of the examined polyps. Conclusion: we conclude as the incidence of malignant transformation of endocervical polyp is low in women in reproductive age and the only critical lesion is in situ intraepithelial neoplasia (CIN), it is proposed to follow an expectant management without interference and those patients can be only followed up to improve their health.

A Rare Case of Paratesticular Leiomyoma Presenting as an Inguinal Hernia

A Rare Case of Paratesticular Leiomyoma Presenting as an Inguinal Hernia

A case of postmenopausal benign metastasizing leiomyoma presenting with bilateral multiple pulmonary nodules

A case of postmenopausal benign metastasizing leiomyoma presenting with bilateral multiple pulmonary nodules

Nasal leiomyoma presenting as sphenopalatine neuralgia: a case report and literature review

Leiomyoma of the nasal cavity constitutes less than 1% of all leiomyoma cases and is known to occur predominantly among the adult female population. Traditionally, intranasal Leiomyoma presents with nasal obstruction and epistaxis. Herein, we report a case of solid-pattern Leiomyoma arising from the right inferior turbinate, presenting exclusively as unresolved sphenopalatine neuralgia symptoms. Endoscopic excision of the tumour successfully alleviates the patient’s symptoms, requiring no further management. An extensive literature search revealed that intranasal Leiomyoma could be successfully managed by endoscopic excision with no recurrence. We highlight the importance of intranasal endoscopic examination in all patients with persistent neuropathic pain of the head and neck.

Clinical Presentation of Uterine Leiomyoma and the Outcome of Surgical Management Options in a Nigerian Tertiary Health Facility

Background: Effective treatment intervention for uterine leiomyoma is essential to prevent morbidities and associated potential mortalities. Objective: To determine the prevalence, clinical presentation of uterine leiomyoma and the outcome of surgical management options at the Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria. Methods: This was a descriptive retrospective study of cases of uterine leiomyoma from 01 January 2012 to 31 December 2016. The medical records of all patients with the diagnosis of leiomyoma were retrieved. Information was obtained on socio-demographics, clinical presentation, types of surgical treatment and associated postoperative complications. Results: Three hundred and thirty-five cases of leiomyoma were managed out of 1835 major gynaecological cases giving a period prevalence of 18.3%. However, only 134 case folders were available for analysis. The mean age of the women was 38.5±6.7 years. Only 21 (15.7%) cases presented within a year of the onset of symptoms. The surgical interventions used included myomectomy and hysterectomy but the former was the commonest with a frequency of 73.4%. There were no significant differences in the prevalence of postoperative complications between patients who had myomectomy and hysterectomy (p>0.05 in each case). Conclusion: Uterine leiomyoma is a common gynaecological condition. There is a need to create awareness of the need to present early to the hospital so that less invasive treatment options can be explored.

Vaginal Leiomyoma Presenting as Pelvic Organ Prolapse in Pregnancy.

Vaginal leiomyomas are extremely rare in pregnancy. These can present in a variety of ways. They can cause mechanical obstruction leading to maternal and perinatal morbidity. Herein, we describe a patient with a vaginal leiomyoma misdiagnosed and operated as pelvic organ prolapse during the second trimester of pregnancy. She presented with a huge vaginal mass, foul-smelling vaginal discharge, difficulty in urination and defecation and septicemia. On examination, she had a large foul-smelling and necrotic mass protruding from the vagina with urethra lying outside the vagina, and sutures visible just above the mass on the anterior vaginal wall. She was admitted and a lower segment caesarian section was done followed by transvaginal resection of the mass, and cystoscopy was done. Vaginal leiomyomas require surgical removal and it is usually curative and recommended as the initial treatment of choice, especially when the tumour is large enough to cause a potential obstacle to normal labour. Key Words: Vaginal leiomyoma, Pelvic organ prolapse, Pregnancy.

Vaginal Leiomyoma Presenting as Pelvic Organ Prolapse in Pregnancy

Vaginal Leiomyoma Presenting as Pelvic Organ Prolapse in Pregnancy

Paraurethral leiomyoma in a 22-year-old woman: A case report

Leiomyoma is a benign fibromuscular neoplasm originating from smooth muscle cells. Paraurethral leiomyoma is an extremely rare, benign, hormone-dependent​ growth from the mesenchymal cells in paraurethral space of female urethra. They usually appear in the reproductive age group women, mean age of presentation being approximately 41 years. A 22-year-old woman presented with palpable mass at vagina and weak urinary stream. She underwent clinical examination and MRI imaging followed by transvaginal excision of the mass. Histopathological examination confirmed paraurethral leiomyoma. Paraurethral leiomyoma make up approximately five percent of urethral tumors. This case depicts the presentation and treatment of a paraurethral leiomyoma in one of the youngest women reported in the literature.

A rare case of giant broad ligament leiomyoma mimicking ovarian malignancy

Broad ligament leiomyomas are uncommon but when they occur they can present in varying degrees of bladder and bowel obstruction. A definite diagnosis of the broad ligament leiomyoma was made after histopathological report of the specimen obtained after operating the patient. A 45 years old female had a history of pain in abdomen and increase abdominal girth for 6 months. On the basis of CT scan a diagnosis of left adnexal mass was made. She was advised surgery and subsequently a mass of 30 cm x 21 cm x 22 cm was resected which weighed 11.05 kgs. : Hyaline degeneration 8 is most common among all of the secondary changes in leiomyomas. However, a dilemma in diagnosis caused by myxoid degeneration. In present case there is presence of both hyaline and myxoid degeneration. This is a unique presentation of a broad ligament leiomyoma which mimicked ovarian malignancy for which staging laparotomy was done.

AB044. SOH22ABS049. Recurrent vasovagal episodes: a rare presentation of a large prolapsed leiomyoma

AB044. SOH22ABS049. Recurrent vasovagal episodes: a rare presentation of a large prolapsed leiomyoma

Paraurethral leiomyoma in a 52 year-old woman: Clinical and diagnostic features and surgical treatment

Leiomyomas are benign tumors of smooth muscle origin occurring throughout the genitourinary system. Sometimes paraurethral leiomyoma can cause a bulking effect on the bladder without gross involvement of the urethra. In our work we describe the case of a woman with a vulvar mass found after self-examination. She was investigated pelvic Magnetic Resonance Imaging (MRI) which showed a well encapsulated solid mass, about 24mm (maximum diameter) located at paraurethral level, on right anterolateral side, It showed uptake of contrast, with a compressive-dislocative effect on the urethra, without involvement of the sphincters. Surgery was performed with excission “en-block” of the mass. The procedure was well tolerated under spinal anesthesia and the patient was discharged 24h later, after removing the bladder catheter. No signs of haematuria nor symptoms of incontinence were reported in the following weeks. Pathology of the excised specimen revealed complete resection of a benign, submucus leiomyoma. Although leiomyomas are very common in organs such as the uterus, the presentation of a urethral leiomyoma, as found in the present case, is very rare. The description of these lesions is however important to create a scientific path that can clarify the cause and the evolution. It can also represent an evolution for imaging through MRI, improving its framework and distinguishing it from malignant tumors that require another surgical strategy.

Role of three-dimensional ultrasound and Doppler in differentiating leiomyoma and adenomyosis of uterus

ObjectiveThe purpose of this study is to evaluate the importance of three-dimensional (3D) power Doppler ultrasound (US) in the diagnosis and differentiation of leiomyoma and adenomyosis of the uterus.BackgroundThe clinical presentation of adenomyosis and leiomyoma overlaps. The 3/4D US imaging has been currently able to produce female pelvis images that are comparable with magnetic resonance imaging and computerized tomography images in both quality and orientation, with the benefit of being without radiation and low cost.Patients and methodsThis study included female patients clinically diagnosed as having uterine leiomyoma and/or adenomyosis and were indicated for hysterectomy. By Doppler velocimetry with the use 3D power Doppler, the waveforms of the ascending main branch of the uterine artery were obtained on both sides of the cervix. Calculation of the resistance index (RI) and pulsatility index (PI) was done in an automatic manner. The averages of arteries on both sides were taken.ResultsThe vascularity of most of the leiomyoma lesions was peripheral and of all of the adenomyosis lesions was central. The adenomyosis group showed significantly decreased vascular index, flow index, and vascular-flow index mean values (P < 0.01), significantly increased uterine artery RI mean values (P < 0.05), and highly significantly increased PI values (P < 0.01).ConclusionThree-dimensional US imaging with power Doppler can increase the accuracy of differentiation between leiomyoma and adenomyosis cases. Significant differences were noted in the vascularity site and Doppler indices.

Vulvar Leiomyoma Presenting as a Painless Vulvar Mass

A 21-year-old woman with a painless 3-cm vulvar mass underneath the right labia minora (Fig. 1) had both a translabial ultrasound (Fig. 2A) and magnetic resonance imaging (Fig. 2B) that demonstrated a well-circumscribed, vascular nodule. A fine needle biopsy was not considered because of its vascular nature. The patient underwent excision of the lesion with an epithelioid leiomyoma of the vulva confirmed histologically (Fig. 3). Fig. 2Imaging. (A) Ultrasound image with color doppler showing border (yellow triangles) and vascular nature of vulvar leiomyoma. (B) Sagittal T2-weighted magnetic resonance image of vulvar leiomyoma (yellow circle). Pubic symphysis (PS) and uterus (UT) labeled for orientation. View Large Image Figure Viewer Download Hi-res image Fig. 3Histology of specimen. (A) Moderate cellular proliferation of epithelioid cells arranged in fascicles and vague nests with some areas showing a watered silk pattern (magnification: 10×). (B) Cells have bland, uniform, round to oval nuclei with ill-defined eosinophilic cytoplasm with virtually no mitotic activity or nuclear pleomorphisms (magnification: 40×). (C) Tumor cells show diffuse staining with smooth muscle actin (magnification: 10×). Images courtesy of Dr. Michelle Meyer. View Large Image Figure Viewer Download Hi-res image

Parasitic Leiomyoma: A Rare Occurrence Following Robotic Hysterectomy

<h3>Study Objective</h3> To highlight the presentation and management of a symptomatic parasitic leiomyoma after a robotic assisted hysterectomy for a multi-fibroid uterus. <h3>Design</h3> Case report. <h3>Setting</h3> Lithotomy, Trendelenburg positioning. <h3>Patients or Participants</h3> C.B. is a 36-year-old G0. <h3>Interventions</h3> Index surgery – Robotic-assisted total laparoscopic hysterectomy and bilateral salpingectomy with mini-laparotomy 1. Robotic-assisted laparoscopic removal of pelvic mass <h3>Measurements and Main Results</h3> C.B. is a 36-year-old G0 who desired definitive management of a symptomatic multi-fibroid uterus. Preoperative ultrasound and MRI displayed an enlarged multi-fibroid 18-week uterus with a dominant 9cm fundal fibroid. Leuprolide acetate was administered for 6 months pre-operatively to reduce the myoma size and anticipated intra-operative blood loss. She underwent a robotic-assisted total laparoscopic hysterectomy and bilateral salpingectomy. A myomectomy was concurrently performed with diathermy to remove an obstructing fibroid for aid in visualization. A mini laparotomy was made to remove the surgical specimen, which was unable to be delivered through vagina. Pathology was benign. C.B. presented one year postoperatively with pelvic pain and bulk symptoms. Her exam was consistent with an adnexal mass and MRI revealed a 6cm pelvic mass. C.B. underwent a robotic-assisted laparoscopic removal of the mass, which was attached to the vaginal cuff. Pathology revealed an infarcted leiomyoma. She followed up postoperatively with complete resolution of her symptoms. <h3>Conclusion</h3> This case highlights a rare occurrence of a parasitic leiomyoma following a hysterectomy. There has been no publication to date describing the occurrence of parasitic myomas after concomitant myomectomy and hysterectomy without morcellation. The authors speculate that seeding of cells during the myomectomy may have been responsible for the development of a parasitic myoma; however, further investigation is needed. This case report also emphasizes the importance of being mindful of the occurrence of parasitic fibroids in a post-hysterectomy patient presenting with pain and pelvic mass.

Colonic leiomyoma mimicking a liver tumor: an unusual diagnosis after en-block robotic resection.

Colonic leiomyomas are rare. Their clinical presentation ranges from asymptomatic polyps detected on endoscopy to large symptomatic abdominopelvic masses. Imaging findings are usually non-specific, and percutaneous biopsy might help with differential diagnosis. However, radical surgery with negative margins is ultimately needed to rule out malignancy. We describe an uncommon presentation of a colonic leiomyoma mimicking a right hepatic lobe tumor on preoperative imaging. The robotic approach allowed a precise abdominal exploration with confirmation of colonic and hepatic infiltration and subsequent oncological en-block resection. Surgeons operating on hepatic tumors close to the right colic flexure should be aware of this diagnosis.

Benign Metastasizing Leiomyoma in the Lung Presenting in a Phyllodes-Like Pattern Mimicking a Biphasic Tumor: A Case Report

Primary biphasic tumors of the lung are rare. Lung lesions with a biphasic pattern are far more commonly primary or metastatic soft tissue tumors with entrapped native respiratory epithelium, giving the false impression of a biphasic tumor. We report a case of bilateral benign metastasizing leiomyomas in a 69-year-old female where the tumor cells diffusely entrapped native respiratory glands in a phyllodes-like pattern. The radiographic characteristics and histologic appearance were not immediately diagnostic and covered a wide differential. Reaching the final diagnosis required the use of immunohistochemical studies as well as correlation with the patient's history and radiographic findings. To the best of our knowledge, this is the first report of pulmonary benign metastasizing leiomyoma presenting in a phyllodes-like pattern. This case illustrates the importance of considering entrapment of native lung epithelium in the differential diagnosis of biphasic-appearing lung tumors.

An unusal presentation of mamoth pseudo broad ligament leiomyoma with cystic degeneratons and hemorrhages: Case report

In reproductive age group extensive mass for abdomen may leads to lots of diagnostic difficulties among those ovarian tumors and uterine fibroids are most favourable diagnosis.Huge fibroids are known to arise from the uterus, although very rarely from extra-uterine sites. Among extra-uterine fibroids, broad ligament fibroids generally achieve enormous size and generally present with pressure symptom like bladder and bowel dysfunction. We report a case of false broad ligament fibroid. This case is reported for its rarity and the diagnostic difficulties in differentiating ovarian tumor and benign fibroid with cystic degeneration. Keywords: Pseudo broad ligament fibroid, Cystic and hyaline changes.