Tumor Of Smooth Muscle Origin Research Articles

Use of monopolar and bipolar radiofrequency probes for treatment of cutaneous leiomyoma

Abstract Cutaneous leiomyomas are tumors of smooth muscle origin which appear as erythematous papules and nodules that are mostly painful to touch. Although surgical excision is the gold standard treatment, other destructive methods such as electrodessication, cryotherapy or carbon-dioxide laser may also be done for cure. Our patient presented with painful cutaneous leiyomyomas which resolved well with radiofrequency ablation done with two different techniques using monopolar and bipolar radiofrequency probes. There was no recurrence at 8 months follow-up.

A Case of Large Cervical Leiomyoma

Uterine Leiomyoma or Myoma or commonly favorite named Fibroid is a most common entity of genital organ tumor. It isalmost benign tumor of smooth muscle origin where smooth muscle fiber and fibrous connective tissue intermingled togetheroften found in uterus. Although it is a disease of nulliparous but in perspective of our country it diagnosed in patient's havingone or two child because of early marrital status. Tumor varies in number 1-200 and also varies different clinical features andseverity depending site of presentation. Leiomyoma is generally slowly progressive disease but sometimes it grows veryrapidly. With the advent of Ultrasonography it is incidentally diagnosed often with asymptomatic cases. UsuallyUltrasonography is the single most predictor of investigation1 from very early cases although MRI is helpful. Asymptomatic large Fibroid present with various unusual symptoms like pressure symptom of surrounding structure or feelingof heaviness of lower abdomen or fullness of abdomen. Large cervical Fibroid is a uncommon presentation with mainly urinarydifficulties where patients chief complaints is frequent micturation and incomplete voiding of urine without significantmenstrual abnormalities. The described cases for urinary complain patient consulted with urologist and referred as a largecervical Fibroid diagnosed by sonography. This article illustrates a case of 34 years old lady present with frequent micturationand incomplete voiding of urine that developed last 5-6 months duration. Total abdominal hysterectomy performed,histologically the specimen showed benign uterine leiomyoma. Post operative circumstance uneventful evaluation occur andpatient back to home with normal duration hospital stay.

A Rare Presentation of Adrenal Leiomyoma Arising in a Ganglioneuroma: A Case Report

Leiomyomas are benign tumours of smooth muscle origin and can occur in any part of the body with adrenal gland being an uncommon site. Ganglioneuromas of adrenal gland are benign neural crest-derived tumours. Both of these tumours are usually detected incidentally. Hereby, the authors report an unusual case of a 31-year-old woman, who presented with paroxysmal attacks of headache, palpitations and flushing pointing towards a hormone secreting adrenal tumour. However, functional adrenal markers were normal. Radiological investigations revealed 8×3 cm heterogeneously enhancing left suprarenal mass with calcification and extension to left renal vein. Patient underwent left nephrectomy and adrenalectomy with a high clinical suspicion of malignancy because of tumour extension to the renal vein. The histopathological examination revealed a leiomyoma arising in a background of ganglioneuroma which was later on confirmed using immunohistochemistry. Authors have presented the present case because of atypical presentation as a hormone secreting adrenal tumour with radiological features of malignancy and the unique histomorphology of the combined occurrence of leiomyoma and ganglioneuromatous area in the adrenal gland. To the best of author’s knowledge, this is the first case report of such an occurrence in the adrenal gland.

Rectal leiomyosarcoma as the initial phenotypic manifestation of Li–Fraumeni-like syndrome: a case report and review of the literature

BackgroundLeiomyosarcoma is a rare malignant tumor of smooth muscle origin and represents 10–20% of all soft tissue sarcomas. Primary colon and rectal sarcomas constitute < 0.1% of all large bowel malignancies. In Li–Fraumeni syndrome, sarcomas are the second most frequent cancer (25%). Li–Fraumeni syndrome is a genetic disease with a familial predisposition to multiple malignant neoplasms. This syndrome has an autosomal dominant pattern of inheritance and high penetrance characterized by germline TP53 mutations. Patients with a history of cancer who do not meet all the “classic” criteria for Li–Fraumeni syndrome are considered to have Li–Fraumeni-like syndrome. To the best of our knowledge, this article is the first report of a patient with rectal leiomyosarcoma as the initial phenotypic manifestation of Li–Fraumeni-like syndrome. The authors also present a literature review.Case presentationA 67-year-old Brazilian woman underwent anterior rectosigmoidectomy and panhysterectomy secondary to rectal leiomyosarcoma. She subsequently developed carcinomatosis and died 2 years after the operation. Her family medical history consisted of a daughter who died at 32 years of age from breast cancer, a granddaughter diagnosed with adrenocortical carcinoma at 6 years of age and two siblings who died from prostate cancer. A genetic study was carried out to identify a pathogenic variant of Li–Fraumeni syndrome. In the DNA extracted from the peripheral blood leukocyte, restriction fragment length polymorphism was analyzed to search for mutations in the TP53 gene. The DNA sequencing identified the germline pathogenic variant p. R337H heterozygous in exon 10 of TP53. The patient was classified as having Li–Fraumeni-like syndrome.ConclusionIn patients with rectal leiomyosarcoma, it is advisable to investigate the family history of cancer and perform genetic studies to screen for Li–Fraumeni syndrome.

Leiomyosarcoma of the kidney with massive thrombosis of the inferior vena cava: a clinical case and a review of the literature

Leiomyosarcoma (LMS) is a rare malignant tumor of smooth muscle origin that usually arises from soft tissues, reduced due to smooth muscle or vessel walls of venous origin. Renal leiomyosarcomas arise from the smooth muscle tissues of the renal pelvis, renal capsule, or renal vessels, and are most commonly encountered. This article presents clinical cases of diagnosis and surgical treatment of renal leiomyosarcoma found in the renal pelvis, complicated by extended thrombosis of the vena cava inferior (VCI).

Molecular subtypes of leiomyosarcoma: Moving toward a consensus

Molecular subtypes of leiomyosarcoma: Moving toward a consensus

S3685 Unusual Stomach Mass: Gastric Metastasis of Malignant Leiomyosarcoma

Introduction: Metastases in the stomach are rare findings, and likely represent a progressive malignant disease. With reported incidence of 0.2%-0.7%, the tumor can spread through hematogenous, lymphatic direct and peritoneal dissemination. Gastric metastases of leiomyosarcoma (LMS), a rare malignant mesenchymal smooth muscle tumor, have only been documented in a handful of case reports. We present a case of metastatic leiomyosarcoma in the stomach presenting with gastrointestinal bleeding. Case Description/Methods: A 64-year-old male with history of metastatic LMS of his left lower extremity came with melena for 3 days. Hemoglobin on presentation was 8.7 g/dl from his baseline of 13-14g/dl. He was diagnosed with grade 3 LMS 3 years ago, involving femoral vessel wall and muscle of his left thigh. He underwent radical excision without any adjuvant chemo and radiotherapy despite recommendations. He subsequently developed metastasis to the lung two years later at which time he started chemotherapy. An esophagogastroduodenoscopy revealed a 6 mm mucosal nodule and a 3 cm mass with a clean based ulcer in the body of stomach. Biopsy, however, was negative for malignancy. He then underwent endoscopic ultrasound guided biopsy for cytology which revealed malignant spindle cell neoplasm in the background of lymphoid tissue consistent with metastatic LMS (Figure 1). Discussion: LMS, a malignant tumor of smooth muscle origin, represents 20%-30% of soft tissue sarcomas. Predominantly uterine in origin, it can arise from the peritoneum, extremities, and blood vessels. Primary gastric LMS has also been reported in literature, but they are extremely rare and now are considered a type of gastrointestinal stromal tumor. LMS has a rapid tendency to metastasize, with lung, peritoneum, bone, and liver being common targets. Some rare cases of LMS metastasizing to pancreas, stomach and oral cavity have been reported. In general, metastases to the stomach are uncommon. The most common gastric metastases come from breast, lung, renal cell cancer and malignant melanoma. Metastasis of LMS to gastric mucosa has been limited to only a handful of case reports with primary tumors arising from kidney, uterus, and broad ligaments. The lesions are described as nodules, submucosal tumors, and ulcerative lesions, most of which are asymptomatic but can present as GI bleeding and abdominal pain. These metastases typically portray a poor prognosis. Local excision of the primary lesion with hormonal therapy and chemotherapy is considered standard treatment.Figure 1.: A. Endoscopic appearance of the metastatic LMS as a gastric body mass with clean based ulcer B. Endosonographic image of the mass in the gastric image.

Mioma uretral: abordagem combinada vaginal e abdominal – um relato de caso

Abstract Introduction: leiomyomas are benign mesenchymal tumors of smooth muscle origin that can develop in various locations. Urethral leiomyomas are rare, with approximately only 120 cases reported in the literature. These tumors often occur in the third and fourth decades of life but are rare in menopausal patients. In general, treatment involves surgery, only three recurrence reports in the literature. Description: a case report on a 56-year-old woman; the patient had type II diabetes mellitus and chronic high blood pressure, was overweight (body mass index, 27.1 kg/m2), and a smoker. Besides this, the patient presented symptoms of urinary obstruction and had a large urethral leiomyoma. The tumor was completely removed with no associated urethral lesions using a complex, combined abdominalvaginal surgical approach. Discussion: the management and treatment on urethral leiomyomas is challenging and have not been established yet due to the rarity of these tumors.

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.

Leiomyoma of face: An unusual presentation: A case report

Leiomyoma is a rare tumor of smooth muscle origin with very low incidence in the Head and Neck region. Oral cavity is devoid of smooth muscles except in blood vessel wall thus this tumor is quiet rare in oral and maxillofacial region with reported incidence of 0.065%. These accounts for 0.42% of all soft-tissue neoplasm in the oral cavity. We are presenting a case of large Leiomyoma of left buccal mucosa which was treated by surgical excision in toto and reconstruction was done by Anterolateral Thigh flap.

Scrotal Leiomyoma: Report of a Rare Case.

Leiomyomas are benign mesenchymal tumours of smooth muscle origin. They can arise anywhere in the body where smooth muscle is present. Superficial leiomyomas are categorised into three types based on their site of origin: piloleiomyoma arising from arrector pili, scrotal arising from dartos, and angioleiomyoma arising from smooth muscles of blood vessels. Scrotal leiomyomas are rare tumour, and very few cases are reported in literature so far. We report a case of scrotal leiomyoma clinically diagnosed as epidermal cyst.

Cutaneous leiomyosarcoma with visceral metastases in a White Carneau pigeon and literature review.

Cutaneous leiomyosarcomas are malignant mesenchymal tumors of smooth muscle origin and are reported occasionally in avian species. A 14-y-old male laboratory White Carneau pigeon (Columba livia) was presented for surgical excision of a cervical soft tissue mass. Ultrasonography with color flow Doppler imaging revealed multiple cavitations of mixed echogenicity within the mass and vascularization. Histologically, the dermis and subcutis were expanded by a densely cellular multinodular mass comprised of fusiform cells forming haphazardly arranged broad streams and short interwoven bundles, often surrounding blood vessels and variably sized cavitations. Neoplastic cells were strongly immunopositive for desmin and α-smooth muscle actin, and negative for pancytokeratin, S100, and von Willebrand factor. Based on histopathology and IHC findings, the cutaneous mass was diagnosed as leiomyosarcoma (LMS). The pigeon died 312 d post-operatively. Postmortem examination revealed masses infiltrating the left and right pulmonary airways and one hepatic nodule, but no regrowth at the surgical site. Histologic and IHC evaluation of the pulmonary and hepatic masses were consistent with LMS, representing metastatic foci from the primary cutaneous LMS. Our case highlights the malignant behavior and histomorphologic features of cutaneous LMS in an avian species.

Abstract PO-015: Hypermethylated genes in leiomyosarcoma can be targeted through guadecitabine treatment

Abstract Leiomyosarcomas (LMS) are aggressive mesenchymal tumors of smooth muscle origin. Understanding the molecular alterations associated with LMS is needed to identify potential therapeutic targets. Epigenetic alterations such as hypermethylation of gene promoter regions with associated transcriptional silencing is a hallmark of most cancers. Epigenetic reprograming is fundamentally linked to tumor initiation, progression and metastasis. Frequent epigenetic alterations have been observed in LMS. Epigenetic drugs such as DNA methyltransferase inhibitors (DNMTi) have been used to reverse aberrant DNA methylation and restore expression of silenced genes. Our previous studies using DNMTi, including guadecitabine, have shown that DNMTi treatment has anti-proliferative and pro-apoptotic effects in in vitro and in vivo models of LMS. Our goal was to characterize the methylation changes following guadecitabine treatment of the leiomyosarcoma cell line SK-UT1. SK-UT1 cells were treated with guadecitabine (0.05 µM-0.1 µM) and methylation was determined using Illumina 450K platform. We filtered the promoter CpG island regions that respond to guadecitabine treatment and were associated with decreased methylation compared to untreated SK-UT1 control (p≤0.05, Δβ≥0.15). In order to assess the relevance of these differentially methylated regions, we compared them to the methylation and expression profiles of LMS patient samples (GSE68312). We focused on the genes that have decreased expression and are associated with increased methylation of the promoter CpG island regions in the patient LMS samples. In conclusion, treatment of SK-UT1 cell line with guadecitabine resulted in decrease of methylation of a subset of promoter CpG island regions that were differentially hypermethylated in LMS patient samples. Further studies are needed to explore the effect of differential methylation on gene expression in guadecitabine treated SK-UT1 cell line. Understanding the effect of DNMTi on LMS is needed to identify potential therapeutic applications targeting the epigenetic pathways. Funding supported by Astex Pharmaceuticals. Citation Format: Nesrin Hasan, Cynthia De Carvalho Fischer, Anup Sharma, Nita Ahuja. Hypermethylated genes in leiomyosarcoma can be targeted through guadecitabine treatment [abstract]. In: Abstracts: AACR Special Virtual Conference on Epigenetics and Metabolism; October 15-16, 2020; 2020 Oct 15-16. Philadelphia (PA): AACR; Cancer Res 2020;80(23 Suppl):Abstract nr PO-015.

S1923 Esophageal Leiomyoma: A Rare, Benign Gastrointestinal Tumor

INTRODUCTION: Leiomyomas are benign tumors of smooth muscle origin that are most commonly seen in the uterus. Leiomyomas of the esophagus are rare tumors but the most common benign lesions of the esophagus originating from smooth muscle cells. Here we present a rare case of esophageal leiomyoma in a 44-year-old male patient with no past medical history. CASE DESCRIPTION/METHODS: The patient is a 44-year-old male with no significant medical history presented to our emergency department (ED) complaining of productive cough, difficulty swallowing and increased salivation. Physical exam and laboratory workup on admission were unremarkable. The patient was then admitted for further workup. Notable imaging included a chest radiograph showing a widened mediastinum. A barium swallow was also done and showed a mass effect on the upper thoracic esophagus at the level of the posterior mediastinum. Computed tomography (CT) scan of the chest was subsequently done and showed a posterior mediastinal mass, possibly arising from the posterior wall of the esophagus (Figure 1). Given the location of the mass, the cardiothoracic surgery and gastroenterology services were consulted. After reviewing the imaging, surgical excision was deemed the best approach. The patient was then taken to the operating room for excision of the posterior mediastinal mass. Biopsies of the mass were sent to pathology and returned showing smooth muscle with mild nuclear atypia. No mitotic activity was noted. Focal areas of hemorrhagic necrosis were present (less than 10%). The smooth muscle phenotype was confirmed with positive staining to smooth muscle actin (SMA) and demsin; and negative staining with CD117, DOG1 (Figure 2). Features were consistent with esophageal leiomyoma. The patient’s post-operative course was uncomplicated and he was discharged home 4 days later. DISCUSSION: Leiomyomas of the esophagus are rare tumors but the most common benign lesion of the esophagus originating from smooth muscle cells. Middle-aged men are most frequently affected. Common symptoms are dysphagia and epigastric pain, but most patients are however asymptomatic. The diagnostic tests include upper endoscopy, endoscopic ultrasonography (EUS) and chest computed tomography (CT). Surgery is considered the treatment of choice and ideally involves enucleation of the tumor.Figure 1.: CT scan of the chest showing a posterior mediastinal mass arising from the posterior wall of the esophagus (blue arrow).Figure 2.: Biopsy of esophageal mass staining positively to Smooth Muscle Antigen (SMA).

Primary Leiomyosarcoma of Humerus Presenting with Pathological Fracture and Treated Initially with Inadvertent Plate Fixation: a Case Report with Literature Review

Leiomyosarcoma is a malignant tumor of smooth muscle origin and commonly diagnosed in the uterus, gastrointestinal tract, and mucous membranes or as metastasis to the skeletal system. Primary leiomyosarcoma of bone is an uncommon type of tumor. Patient with primary bone sarcoma may present with a pathological fracture following a trivial injury, resulting in pain, swelling, and deformity. The pathological fracture needs to be evaluated with a high index of suspicion and proper investigations must be performed prior to fracture fixation. We present a case of primary leiomyosarcoma of humerus, who presented as pathological fracture and underwent inadvertent plating at a peripheral hospital. We treated this patient with wide resection of the tumor and the reconstruction was performed with an implant (Kuntscher’s nail and extra-articular plate) with bone cement spacer. The use of this novel method allowed us to perform implant fixation with small distal humerus bone segment and preserve native elbow joint. In this case report, we aim to highlight the importance of thorough preoperative evaluation and keeping a high index of suspicion while dealing with suspected pathological fractures to differentiate between primary and metastatic disease.

Anatomical locations of uterine fibroids in Sudanese women

Uterine fibroids are the commonest uterine neoplasms, they are benign tumors of smooth muscle origin. The study was done to look for the anatomical locations of uterine fibroids and their incidence in Sudanese women at Omdurman Maternity Hospital between 1st July 2014 to 5th October 2015. Their sociodemographic and ultrasound data were collected using a prepared questionnaire. The study included 138 confirmed cases of uterine fibroids out of 2968 investigated cases representing incidence rate of 4.6%. The highest incidence was found in the age group 36-40 years. Most dominant anatomical locations of uterine fibroids were intramural as a single mass (34.78%), followed by the intramural-subserosal in multiple masses (20.29%). The anatomical positions of uterine fibroids, posterior position was seen in (27.5%) which was the most dominant in single uterine fibroid mass, followed by the anterior-posterior position in multiple uterine one (18.1%). Intramural anatomical locations in single mass are the commonest uterine fibroids types which affect the Sudanese women.&#x0D; Key words: Anatomical locations; Uterine fibroid and leiomyomas

An Unusual Presentation of Leiomyosarcoma Posing a Diagnostic Dilemma: A Case Report

Leiomyosarcoma (LMS) is a malignant tumour of smooth muscle origin commonly seen in genital and gastrointestinal location. However, its presence in the head and neck region in a young child is extremely rare. Authors present a unique case of LMS in a one year and five-month-old child who presented with a painless mass in the right temporal region of the head. Histopathological examination revealed a highly cellular tumour arranged in intersecting fascicles of spindle cells with brisk mitotic activity and interspersed areas of necrosis. On Immunohistochemistry (IHC), the tumour cells were positive for Smooth Muscle Actin (SMA), Desmin and Vimentin and negative for S100 and Myogenin. A diagnosis of LMS was thus, made. Head and neck sarcoma is a broad entity encompassing plethora of differentials with closely overlapping morphological features which renders them diagnostically challenging, this can be resolved by employing various immunohistochemical stains readily available in all laboratories. This case highlights the combined role played by histopathology and immunohistochemistry in arriving at the correct diagnosis. To the best of our knowledge, this is the first case of LMS reported in the temporal region of head and is distinct with respect to its rare incidence, location and age at presentation. LMS at this site may masquerade as deceptively benign painless mass and may not be suspected initially, however one should bear in mind that these are moderate-to-high grade tumours and any delay in management may portend poor prognosis. Timely and aggressive surgical management is thus, the mainstay of treatment and critical to patient survival.

The largest adrenal leiomyoma: A case report and literature review

Leiomyoma is a benign tumor of smooth muscle origin. Primary leiomyoma of the adrenal gland is very rare. Adrenal tumors are often diagnosed during the ultrasound or computerized tomography (CT) study as incidentaloma. According to the literature review, up to 2018, the largest size of adrenal leiomyoma which had ever been reported was 12 × 10 × 8 cm in dimension (Maher et al.). Herein, we report the largest adrenal leiomyoma with the tumor mass of 600 g (14,1x11,4x10,1 cm) from a female patient admitted to our hospital.

Leiomyoma of the Urinary Bladder: A Review and Update

Leiomyoma of the urinary bladder / leiomyoma of the ureter is a very rare benign tumour of smooth muscle origin which has been reported sporadically globally. Leiomyoma of the urinary bladder/ureter may be diagnosed incidentally during investigation of various conditions including infertility and hepatitis. Leiomyoma of the urinary bladder / ureter may manifest in female as well as in a male patient with non-specific symptoms including lower urinary tract symptoms / retention of urine, haematuria, loin pain/discomfort, urinary tract infections and cystitis. The general and systematic examinations may be normal but at times there may be a palpable mass within the area of the urinary bladder on bimanual examination but not always. There may occasionally be tenderness in the loin. The results of routine haematology and biochemistry blood tests would generally tend to be normal but there may be anaemia and impairment of renal function some cases of visible haematuria and obstruction of the ureter respectively. Ultrasound scan would tend to illustrate a well-circumscribed polypoidal soft tissue mass projecting into the urinary bladder or within the intramural area of the bladder. Intravenous urography would show a filling defect in the urinary bladder. CT and MRI scans of abdomen and pelvis with contrast would show a well-defined round mass in the area of the bladder which could be iso-tense to skeletal muscles on T1 and T2 weighted images and occasionally may show cystic areas of necrosis. Cystoscopy would show the lesion projecting into the urinary bladder at the specific area of the urinary bladder involved and at times the projecting lesion would be covered by normal looking urothelial mucosa and on other occasions when the lesion is large and in the area of a ureteric orifice the specific ureteric orifice would not be visualized. Diagnosis of leiomyoma of the urinary bladder / ureter would be confirmed upon histopathology and immunohistochemistry study features of trans urethral resection biopsies of the lesion which would tend to show smooth muscle spindled-cells with no evidence of atypia, or necrosis, or haemorrhage and associated with a low Ki67 index. Trans-urethral resection of the urinary bladder lesion tends to be undertaken for small to medium sized lesions with good outcome but this tends to be associated with about 18% recurrence rate that would require further resections or surgical excision to ensure complete removal of the lesion and no further recurrences. Surgical excision of the lesion including partial cystectomy, local excision / enucleation have been very effective for the treatment of larger leiomyomas with no reported recurrence so far; nevertheless, patients who undergo augmentation cystoplasty or total cystectomy and urinary diversion would need to cope with the functional problems related to the cystoplasty or urinary diversion. Differential diagnoses of leiomyoma of the urinary bladder / ureter include leiomyosarcoma, urothelial carcinoma and other malignant lesions affecting the urinary bladder. There is need for clinicians to explore minimal invasive surgery to treat patients who have leiomyoma of the bladder / ureter especially those who have multiple co-morbidities and the alterative management options that could be undertaken in multi-centre trials include: Cryotherapy, radiofrequency ablation, irreversible electroporation, high frequency ultrasound treatment and super-selective embolization of the arterial branch supplying the leiomyoma. Patients who develop ureteric obstructions would additionally require nephrostomy insertions or insertion of ureteric stents as a temporary measure to improve their renal functions.

Rare case of an anorectal leiomyoma

Introduction. Leiomyoma is a kind of benign tumors of smooth muscle origin, occurring mostly throughout the genitourinary system. They are rarely found in the anorectal region, where they represent less than 0.1% of the tumors of the rectum. Due to this exceptional occurrence, we report a case of leiomyoma arising in the anorectal region. Case outline. A 43-year-old otherwise healthy woman presents with the big mass in analorectal region. Major complain is pain and discomfort while sitting. Magnetic resonance imaging is done and pathohistology report confirmed large leiomyoma. Abdominoperianeal resection of the rectum was performed due to the size of the tumor. Postoperative course was uneventful. Conclusion. There is no gold standard technique, and decision about the best surgical approach for all pathohistological types of tumors in the anorectal region. The decision sometimes has to be made according to size and major complains.