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Dong X, Zheng A, Pan C, Guo T. Cotyledonoid Dissecting Leiomyoma of the Uterus: A Benign Uterine Tumor with Resembles Malignancy Appearance. J Minim Invasive Gynecol 2024:S1553-4650(24)00236-X. [PMID: 38801986 DOI: 10.1016/j.jmig.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Xue Dong
- Gynecology and Obstetrics Department (Drs. Dong, Zheng and Guo), West China Second Hospital, Chengdu, Sichuan, China; Ambulatory Surgery Department (Dr. Dong), West China Second Hospital, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Drs. Dong, Zheng, and Guo), Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Ai Zheng
- Gynecology and Obstetrics Department (Drs. Dong, Zheng and Guo), West China Second Hospital, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Drs. Dong, Zheng, and Guo), Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Changqing Pan
- Gynecology and Obstetrics Department (Dr. Pan), Affiliated Hospital of University Electronic Science and Technology Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Tao Guo
- Gynecology and Obstetrics Department (Drs. Dong, Zheng and Guo), West China Second Hospital, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Drs. Dong, Zheng, and Guo), Sichuan University, Ministry of Education, Chengdu, Sichuan, China.
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Chahkandi M, Ataei M, Bina AR, Mozayani F, Fanoodi A. Cotyledonoid dissecting leiomyoma of the uterus: a case report and review of the literature. J Med Case Rep 2023; 17:516. [PMID: 38102631 PMCID: PMC10724900 DOI: 10.1186/s13256-023-04271-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Cotyledonoid dissecting leiomyoma, also named Sternberg tumor, is a rare variant of uterine leiomyoma. The tumor is benign, but the appearance and growth pattern are unusual and alarming. In this article, we report a case of cotyledonoid dissecting leiomyoma in a 55-year-old woman as well as review relevant literature. CASE PRESENTATION We report a case of cotyledonoid dissecting leiomyoma in a 55-year-old Iranian woman who presented with vaginal bleeding 4 months after menopause. Ultrasound showed two heterogeneous hypoechoic masses on the uterine fundus. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed for the patient. Macroscopically, a large heterogeneous intramural mass (140 mm × 120 mm × 120 mm) with a grape-like exophytic mass on the fundus was observed. Her health status was good after surgery, and the patient was discharged from the hospital after 2 days. In a 1-year follow-up period, no recurrence or any other related complications were found. CONCLUSION It is important to recognize this rare variant of leiomyoma to prevent aggressive and inappropriate overdiagnosis and overtreatment. It is suggested to try to use frozen sections for better diagnosis and to preserve fertility in young women suffering from this lesion.
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Affiliation(s)
- Mahboobeh Chahkandi
- Department of Pathology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Marzieh Ataei
- Department of Obstetrics and Gynecology, Clinical Research Development Unit, Vali-e-Asr Hospital, Birjand University of Medical Sciences, Birjand, Iran
| | - Amir Reza Bina
- Student Research Committee, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Farnaz Mozayani
- Student Research Committee, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Ali Fanoodi
- Student Research Committee, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran.
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Abreu RF, Bovolim G, Baiocchi G, De Brot L. Cotyledonoid dissecting leiomyoma of the uterus: a gross and radiologic malignancy mimicker. Int J Gynecol Cancer 2023; 33:1827-1829. [PMID: 37419515 DOI: 10.1136/ijgc-2022-004119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023] Open
Affiliation(s)
| | | | | | - Louise De Brot
- Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
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Martínez-Cachero García M, Menéndez de Llano Ortega R, Martínez Camblor L, Carrasco Aguilera B, Rodríguez Castro J, Gómez Illán R. Extrauterine leiomyomatosis, the great mimicker. RADIOLOGIA 2023; 65:251-257. [PMID: 37268367 DOI: 10.1016/j.rxeng.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/08/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Describe the radiographic features of the different forms of extrauterine leiomyomatosis. CONCLUSIONS Leiomyomas with a rare growth pattern occur most often in women of reproductive age and with a history of hysterectomy. Extrauterine leiomyomas present a greater diagnostic challenge because they may mimic malignancies, and serious diagnostic errors may result.
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Affiliation(s)
| | | | - L Martínez Camblor
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - B Carrasco Aguilera
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Rodríguez Castro
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Spain
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5
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Martínez-Cachero García M, Menéndez de Llano Ortega R, Martínez Camblor L, Carrasco Aguilera B, Rodríguez Castro J, Gómez Illán R. Leiomiomatosis extrauterina, la gran simuladora. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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6
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The Management of the Cotyledonoid Leiomyoma of the Uterus: A Narrative Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168521. [PMID: 34444270 PMCID: PMC8393327 DOI: 10.3390/ijerph18168521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
Cotyledonoid leiomyoma is an unusual uterine myoma due to some ultrasound features that mimic a malignant lesion facilitating the choice of radical surgery. This study aims to summarize the ultrasound and the magnetic resonance imaging aspects of this atypical lesion, and also discuss surgical treatment and pathological exam. It included all English case reports or case series until August 2021 found through PubMed, Google Scholar, and Scopus. A total of 94 cotyledonoid leiomyomas were reported, with a median tumor size of 12 cm. The typical ultrasound image is characterized by a large solid heterogeneous mass, with high vascularity, no shadowing, and indistinct margins within the myometrium. Magnetic resonance imaging shows the presence of merging isointense nodules to the myometrium in T1-weighted images, hyperintense in T2-weighted images, and contrast agent enhancement. Surgical treatment consists of hysterectomy (75 cases, 80%) or myomectomy (19 cases, 20%), without evidence of recurrence if complete. The placenta-like appearance observed during surgery supports this rare fibroid hypothesis. The intraoperative frozen section can be considered. Microscopically, no atypical cells, signs of mitotic activity or cell necrosis are found. To conclude, some preoperative and intraoperative aspects of this lesion are distinctive and may lead surgeons to opt for conservative surgery.
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Buonomo F, Bussolaro S, Giorda G, Romano F, Biffi S, Ricci G. Cotyledonoid Leiomyoma Clinical Characteristics, Imaging Features, and Review of the Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1459-1469. [PMID: 32955750 DOI: 10.1002/jum.15510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/19/2020] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Abstract
Cotyledonoid leiomyoma of the uterus is a rare variant of benign uterine leiomyoma. It has a favorable attitude, despite some ultrasound presentations. A bulky uterus with a heterogeneous mass with irregular margins, high vascularity, and infiltration of the myometrium can induce the suspicion of a malignant mesenchymal tumor and lead to a radical surgical treatment. If present, some imaging features may suggest this rare type of leiomyoma, thus avoiding extensive surgery, especially in young nulliparous women. We report 13 cases of cotyledonoid leiomyoma with clinical characteristics, imaging features, and a literature review.
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Affiliation(s)
- Francesca Buonomo
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Via Dell'Istria 65, Trieste, 34137, Italy
| | | | - Giorgio Giorda
- Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Federico Romano
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Via Dell'Istria 65, Trieste, 34137, Italy
| | - Stefania Biffi
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Via Dell'Istria 65, Trieste, 34137, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, Via Dell'Istria 65, Trieste, 34137, Italy
- University of Trieste, Trieste, Italy
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8
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Cotyledonoid dissecting leiomyoma: an uncommon form of a common disease. Obstet Gynecol Sci 2019; 62:362-366. [PMID: 31538081 PMCID: PMC6737059 DOI: 10.5468/ogs.2019.62.5.362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/24/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022] Open
Abstract
Leiomyomas are benign uterine smooth muscle neoplasms with varied morphology that are well known to undergo secondary changes. Cotyledonoid dissecting leiomyoma is a rare and distinct form of leiomyoma that poses a diagnostic challenge for clinicians, radiologists, and pathologists and can be confused with malignant uterine neoplasms. Only a few cases have been reported so far in the literature. Here we report a case of a cotyledonoid dissecting leiomyoma in a 60-year-old woman, emphasize its gross and histological features, and provide a review of the literature.
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Devereaux KA, Schoolmeester JK. Smooth Muscle Tumors of the Female Genital Tract. Surg Pathol Clin 2019; 12:397-455. [DOI: 10.1016/j.path.2019.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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10
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Smith H, Jung N, Carter A, Watson M, Singh A. Post-hysterectomy extrauterine cotyledonoid leiomyoma in a 42-year-old female. Urol Case Rep 2018; 19:16-17. [PMID: 29888178 PMCID: PMC5991331 DOI: 10.1016/j.eucr.2018.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 11/18/2022] Open
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Xu T, Wu S, Yang R, Zhao L, Sui M, Cui M, Chang W. Cotyledonoid dissecting leiomyoma of the uterus: A report of four cases and a review of the literature. Oncol Lett 2016; 11:2865-2868. [PMID: 27073566 DOI: 10.3892/ol.2016.4314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 02/16/2016] [Indexed: 12/13/2022] Open
Abstract
Cotyledonoid dissecting leiomyoma (CDL), also termed Sternberg tumor, is a variant of uterine leiomyoma that is rarely diagnosed by clinical evaluation. At present, ~43 cases of CDL have been reported in the literature written in the English language. Due to the distinctive grapelike gross appearance of an exophytic mass resembles placental tissue, CDL is often misdiagnosed clinically as an ovarian tumor or uterine sarcoma. Therefore, an awareness of the features of the disease is important to prevent misdiagnosis and overtreatment. The present study reports 4 cases of CDL of the uterus that were treated at the Second Hospital of Jilin University between January 2009 and December 2011. All 4 patients in the current study presented with a palpable asymptomatic pelvic mass, which was detected during physical examinations, and cancer antigen 125 tumor marker levels that were within the normal range. The exploratory laparotomy of the 4 patients revealed lobulated tumors with a grapelike appearance extending from the lateral uterine wall into the ligament or the adjacent tissues. The frozen section and postoperative pathology were diagnosed as CDL. A total abdominal hysterectomy was performed in the first case of a 55-year-old woman that had been in menopause for 7 years. The patient was well and showed no evidence of disease subsequent to 48 months of follow-up. A total abdominal hysterectomy and right salpingo-oophorectomy were performed in the second case of a 43-year-old woman, who was well and showed no evidence of disease subsequent to 26 months of follow-up. A subtotal abdominal hysterectomy and bilateral salpingectomy were performed in the third case of a 37-year-old woman, who was well and showed no evidence of disease subsequent to 27 months of follow-up. A total abdominal hysterectomy and right-salpingectomy were performed with the removal of a retroperitoneal fibroid extension in the fourth case of a 48-year-old woman, who was well and showed no evidence of disease subsequent to 32 months of follow-up.
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Affiliation(s)
- Tianmin Xu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Shuying Wu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Rulin Yang
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Liping Zhao
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Mingxing Sui
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Manhua Cui
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Weiqin Chang
- Department of General Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
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12
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Van den Bosch T, Dueholm M, Leone FPG, Valentin L, Rasmussen CK, Votino A, Van Schoubroeck D, Landolfo C, Installé AJF, Guerriero S, Exacoustos C, Gordts S, Benacerraf B, D'Hooghe T, De Moor B, Brölmann H, Goldstein S, Epstein E, Bourne T, Timmerman D. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:284-98. [PMID: 25652685 DOI: 10.1002/uog.14806] [Citation(s) in RCA: 372] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/18/2015] [Accepted: 01/27/2015] [Indexed: 05/14/2023]
Abstract
The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. The terms and definitions described may form the basis for prospective studies to predict the risk of different myometrial pathologies, based on their ultrasound appearance, and thus should be relevant for the clinician in daily practice and for clinical research. The sonographic features and use of terminology for describing the two most common myometrial lesions (fibroids and adenomyosis) and uterine smooth muscle tumors are presented.
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Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - M Dueholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute L Sacco, University of Milan, Milan, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C K Rasmussen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - A Votino
- Department of Obstetrics and Gynecology, Brugmann University Hospital, Brussels, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - C Landolfo
- Department of Obstetrics and Gynecology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A J F Installé
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - S Guerriero
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria of Cagliari and University of Cagliari, Cagliari, Italy
| | - C Exacoustos
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Clinic, University of Rome 'Tor Vergata', Rome, Italy
| | - S Gordts
- L.I.F.E. (Leuven Institute for Fertility & Embryology), Leuven, Belgium
| | - B Benacerraf
- Departments of Radiology and Obstetrics & Gynecology, Harvard Medical School, Boston, MA, USA
| | - T D'Hooghe
- Leuven University Fertility Centre, University Hospitals KU Leuven, Leuven, Belgium
| | - B De Moor
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - H Brölmann
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - E Epstein
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - T Bourne
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
- Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
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13
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Blake EA, Cheng G, Post MD, Guntupalli S. Cotyledonoid dissecting leiomyoma with adipocytic differentiation: A case report. Gynecol Oncol Rep 2014; 11:7-9. [PMID: 26076084 PMCID: PMC4434163 DOI: 10.1016/j.gore.2014.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/24/2014] [Indexed: 12/18/2022] Open
Abstract
•The second case of cotyledonoid dissecting lipoleiomyoma documented in the literature is reported.•Cotyledonoid dissecting leiomyoma presents in a similar manner as aggressive malignancies; however, it is a benign lesion.•Recurrence of cotyledonoid dissecting leiomyoma is exceedingly rare with only one documented recurrence following conservative treatment.
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Affiliation(s)
- Erin A. Blake
- Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA
- Corresponding author at: Department of Obstetrics and Gynecology, University of Colorado-Denver School of Medicine, Academic Office 1, Room 4010, 12631 E. 17th Avenue, Mailstop B198-1, Aurora, CO 80045, USA.
| | - Georgina Cheng
- Department of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA
| | - Miriam D. Post
- Department of Pathology, University of Colorado, Denver, CO, USA
| | - Saketh Guntupalli
- Department of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA
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14
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Geynisman J, Pagan C, Pirog E, Holcomb K. Cotyledonoid dissecting leiomyoma. Int J Gynaecol Obstet 2014; 125:284. [PMID: 24725392 DOI: 10.1016/j.ijgo.2013.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 12/17/2013] [Accepted: 02/06/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Julia Geynisman
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell, New York, NY, USA
| | - Carlos Pagan
- Department of Pathology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
| | - Edyta Pirog
- Department of Pathology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
| | - Kevin Holcomb
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell, New York, NY, USA.
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15
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Kim NR, Park CY, Cho HY. Cotyledonoid dissecting leiomyoma of the uterus with intravascular luminal growth: a case study. KOREAN JOURNAL OF PATHOLOGY 2013; 47:477-80. [PMID: 24255637 PMCID: PMC3830996 DOI: 10.4132/koreanjpathol.2013.47.5.477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 12/24/2012] [Accepted: 01/03/2013] [Indexed: 11/28/2022]
Abstract
Here, we report the case of a 43-year-old female who was diagnosed with a cotyledonoid dissecting leiomyoma (CDL) of the uterus. CDL is a recently described and extremely rare variant of a benign leiomyoma that can grossly masquerade as a malignancy. The 13-cm sized tumor was located primarily on the extrauterine surface as an intrauterine continuity, which showed dark red, congested, bulbous protuberances. It was multinodular appearance, encasing the bilateral adnexae and the left iliac vein. Microscopically, the nodules were separated by extensive hydropic degeneration. The nodules were composed of cigar-shaped spindle cells with no mitosis, cellular pleomorphism or coagulation necrosis. They also showed an intravascular luminal growth pattern. CDL with intravascular growth was diagnosed after excluding intravascular leiomyomatosis, disseminated peritoneal leiomyomatosis, and benign metastasizing leiomyoma. The present case is the second reported case of CDL in Korea. Recognition of this rare and bizarre, malignancy-mimicking leiomyoma is crucial to prevent inappropriate treatment.
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Affiliation(s)
- Na Rae Kim
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
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16
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Onu DO, Fiorentino LM, Bunting MW. Cotyledonoid dissecting leiomyoma as a possible cause of chronic lower back pain. BMJ Case Rep 2013; 2013:bcr-2013-201350. [PMID: 24121815 DOI: 10.1136/bcr-2013-201350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Uterine fibroids having the distinct pathological and immunohistochemical features of cotyledonoid dissecting leiomyoma have been reported infrequently. We describe a postmenopausal woman with an incidental finding of an abdominopelvic mass arising from the uterine fundus on routine radiological imaging of the lumbar spine. The imaging was performed for the investigation of chronic radicular lower back pain refractory to usual pain management. However, the woman did not manifest any gynaecological symptoms. Intraoperatively, the pelvic mass appeared malignant and a frozen section suggested uterine sarcoma. As such, the mass was radically resected, resulting in significant resolution of the back pain. To the authors' knowledge, this is the first report of cotyledonoid dissecting leiomyoma presenting solely as chronic lower back pain, and also the first report of this fibroid variant in Australasia. We discuss the diagnostic and operative challenges, emphasising the role of radiological imaging and immunohistopathology in such cases and review current literature.
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Affiliation(s)
- David O Onu
- Department of Gynaecological Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia
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