Aims: We present the histopathological findings of a series of six cases of a benign uterine smooth muscle tumour with an unusual growth pattern.. Methods and results: All cases have the appearances of the recently described dissecting (cotyledonoid) leiomyoma.In addition, three of these lesions demonstrate the … Earlier age of menarche and nulliparous women have higher risk. Pedunculated: Submucosal and subserosal tumors can be pedunculated with the presence of narrow pedicle. Ultrasonography (US) showed a heterogeneous abdominopelvic mass. The nodules were composed of cigar-shaped spindle cells with no mitosis, cellular pleomorphism or coagulation necrosis. Huge leiomyoma with myxoid degeneration (cystic spaces) on cut section Most often asymptomatic. Morphology: This is a complication usually occurs in pregnancy. Ovary tumor - Leiomyoma. Submucosal: present benath the endometrium. Hyalinization is the commonest type of degeneration. Reports of leiomyoma with marked cystic degeneration have been relatively uncommon (Aydin et al., 2013). Diffuse hydropic degeneration is considered much less common and may result in exceptionally large tumors, depending on the degree of fluid accumulation . Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. The mass grossly contained serous and hemorrhagic fluids in the cavities, and pathology examination confirmed that the mass was a leiomyoma with hydropic and cystic degeneration. The common cause is due to obstruction of venous drainage at the periphery of the lesion. Gross: Subserosal they are seen beneath the serosa. Loves to promote social media for education in Pathology, Designed by Elegant Themes | Powered by WordPress, ANTICOAGULANTS in Hematologic Investigations, Understanding AZZOPARDI PHENOMENON / EFFECT. is present around smooth muscle bundles Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. Can cause pressure symptoms due to compression on adjoining structures. There are many microscopic variants which include cellular, Leiomyoma with bizzare nuclei, Mitotically active, hydropic, apopletic, lipomatous, epithelioid, myxoid, dissecting leiomyomas etc. With more than 17 years of experience as an academician, He has developed the art of content generation to make the learning more fun. Occasionally uterine tumors may detach and results in a rare type called PARASITIC leiomyoma. The tumor is diagnosed histologically by a pathologist by observing a tumor … Leiomyomas can occur in any age group but more common in 30 to 50 years. Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. Etiology: Exact etiology is not known, however age of menarche and parity are important risk factors. There are no clinical findings that reliably differentiate ordinary leiomyomas from leiomyoma variants and leiomyosarcomas. Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. 4. leiomyoma might have a unique clinical presentation involving concomitant uterine adenomyosis. Multinodular hydropic leiomyoma (MHL) of the uterus is one of the rarest variants of uterine leiomyomas and can create some diagnostic problems. arrow) at the cornu; hydropic change Diffuse, perinodular, and other patterns of hydropic degeneration within and adjacent to uterine leiomyomas: problems in differential diagnosis. The tumor cells were positive for the microphthalmia transcription factor but negative for other melanoma markers. Apple Green Birefringence. Pathology confirmed that the mass was a leiomyoma with hydropic and myxoid degeneration. However, we cannot answer medical or research questions or give advice. Increased awareness of this grossly alarming variant of benign uterine leiomyoma can help avoid overtreatment. Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. Posted by Dr Vijay Shankar S | Jan 11, 2021 | Female Genital System & Breast |. No striated muscle tissues were noted between the tumor and resection margin, but a thin smooth muscle layer, positive for hormone receptors, was present at the periphery, suggesting the origin of the tumor. Abstract. They can be single or multiple. Geographic areas of hydropic degeneration were identified (Fig. The present case was uncommon in that it exhibited umbilical endometriosis, an extremely enlarged uterus due to marked hydropic and cystic degeneration of the leiomyomas, and torsion of the pedicle of the right ovarian cyst that had caused sudden pain in the right lower abdomen. The cut surfaces are well circumscribed, with greywhite and whorled cut surface. They also showed an intravascular luminal growth pattern. Magnetic resonance imaging (MRI) was performed to further … © Copyright PathologyOutlines.com, Inc. Click, Also called dissecting cotyledonoid leiomyoma, Sternberg tumor (, Rare benign tumor characterized by extrauterine bulbous growth continuous with a dissecting myometrial component, Dissecting leiomyomas rarely are due to noncotyledonoid variants (, 55 year old woman whose tumor had alarming gross appearance (, 63 year old woman with epithelioid variant (, Multinodular, exophytic congested bulky tumor resembling placenta extends from uterine wall into broad ligament and pelvic cavity, Reddish brown with multiple bulbous processes protruding over uterine surface, Fascicles and nodules of bland smooth muscle cells, prominent hydropic degeneration, No necrosis, no mitotic figures and no atypia. These are the ones which can manifest with menorrhagia. Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. Cotyledonoid hydropic intravenous leiomyomatosis: a new variant leiomyoma. 1) was described and distinguished from the interstitial hyaline degeneration that is commonly seen in uterine leiomyomata. 21 year old woman with bilateral massive ovarian leiomyomata (Mod Pathol 1992;5:586) 31 year old woman with primary ovarian leiomyoma associated with endometriotic cyst presenting with symptoms of acute appendicitis (Diagn Pathol 2009;4:25) 79 year old woman with leiomyoma of the ovary presenting with Meigs' syndrome (J Obstet Gynaecol Res … Specifically, a rapidly growing uterine mass is not a reliable predictor of leiomyosarcoma according to Parker et al. (perinodular hydropic degeneration), 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA). Polarizing Microscopy Simplified! Cystic change, an extreme form of hydropic degeneration is a rare clinical presentation. A leiomyoma is a benign smooth muscle tumor that can develop anywhere in the body Hydropic Leiomyoma of Uterine Corpus is an uncommon morphological variant of Uterine Corpus Leiomyoma. But can manifest with abnormal uterine bleeding which is more common in submucosal leiomyomas. Address correspondence and reprint requests to Dr. Lawrence M. Roth, Department of Pathology, University Hospital, Room 3465, 550 North University Boulevard, Indianapolis, IN 46202-5280, U.S.A. ... and one was a multinodular leiomyoma with hydropic degeneration. 2. Cotyledonoid leiomyoma apparently results from a combination of several uncommon growth patterns operating together, including subserosal growth, dissecting growth, and perinodular hydropic degeneration. The individual smooth muscle cells are uniform in size and shape and have characteristic oval to elongated with blunt ends ( CIGAR shaped). Background: Leiomyomas rarely cause pseudo-Meigs syndrome. These are usually multiple with sizes ranging from microscopic foci to large bulky tumors. 2 The uterus can enlarge and may have a lobulated contour. The most common abnormalities are translocations on chromosome 12; deletion on chromosomes 3q and 7q. Edematous change, referred to as hydropic degeneration, is a common form of degeneration seen focally in up to 50% of patients with leiomyoma . Occasionally uterine tumors may detach and results in a rare type called PARASITIC leiomyoma. It is critical for ... 1Department of Pathology, KKR Sapporo Medical Center, 6-3–40, Ichijyo, Hiragishi, Toyohira-ku, Sapporo, Hokkaido 062-0931, Japan ... marked hyalinized degeneration and hydropic change (Fig. Red Degeneration: This is due to hemorrhagic infaction of a leiomyoma. pathology examination confirmed that the mass was a leiomyoma with hydropic and cystic degeneration. Microscopy: the pattern is that of interlacing fascicles or whorling of smooth muscle cells. Based on the location of the tumor they are categorized as Table 1 summarizes ordinary leiomyomas, including their various forms of degeneration, and their main variants. A presumed direct relation between the abundance of intratumoral fluid and presence of ascites seemed justified. 2b). Am J Surg Pathol. Hydropic degeneration is characterized by accumulation of oedema fluid with associated collagen deposition presenting with various patterns [5], [6]. Leiomyoma dissects into myometrium (black arrow) at the cornu; hydropic change is present around smooth muscle bundles (perinodular hydropic degeneration) Author information: (1)Department of Pathology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur. We describe a case of a 35-year-old woman with a pedunculated uterine leiomyoma with diffuse hydropic degeneration presenting as a giant abdominal mass. This is also referred to as Carneous degeneration. Saeed et al. The mass grossly contained serous and hemorrhagic fluids in the cavities, and pathology examination confirmed that the mass was a leiomyoma with hydropic and cystic degeneration. It is a close mimicker of malignancy due to rapid growth and atypical imaging appearances. Hydropic change is another form of degeneration with a similar MRI appearance, and is due to an accumulation of oedema fluid in the connective tissue of the leiomyoma. Most important risk factor is exposure to environmental estrogens before puberty. The incidence decreases after menopause. Hyaline degeneration consisting of nodular confluent acellular areas (Fig. The cytoplasm s abundant and eosinophilic with elongated bipolar processes. No reported case of pseudo-Meigs syndrome presenting with hydropic degeneration of uterine leiomyoma and an elevated CA 125 level could be found on a MEDLINE search. They can also interfere in fertility. reviewed 20 cases of cotyledonoid dissecting leiomyoma . Am J Surg Pathol. Cytogenetic abnormalities: 40 to 50% of uterine leiomyomas show karyotypic abnormalities. Pathology When the leiomyomas increase in size, the vascular supply to it becomes inadequate and leads to different types of degeneration which are hyaline, cystic, myxoid, or red degeneration and dystrophic calcification may also occur. 2) and distinguished from the interstitial edema commonly seen in leiomyomata. Hydropic degeneration of uterine leiomyoma mimicking a huge ovarian cyst Ifeyinwa Mary Asuzu, Emmanuel Ugwa, Kevin Nwabueze Ezike ABSTRACT Introduction: Leiomyomas are very common neoplasms of the female genital tract. The patient was admitted in the emergency department because of diffuse abdominal bloating and discomfort. Leiomyomas can undergo degeneration, which can result in a variety of sonographic appearances. Hydropic degenerating leiomyomas are characterized by focal accumulation of edema and collagen deposition. These are usually asymptomatic if small and are often incidental finding. Uncomplicated leiomyomas are of a heterogeneous echo texture and vary from hypoechoic to hyperechoic, sometimes containing calcifications with acoustic shadowing. Increased levels of CA 125 often are associated with some types of malignancy. Leiomyomas with hydropic change do not have thick smooth muscle cells fascicles but a delicate filigree pattern with oedema fluid as extracellular material [1]. Genes involved : HGMA2, ESR2, RAD5 & MED12, Clinical features: Highly cellular variant and lipoleiomyomas will be yellowish in color. This website is intended for pathologists and laboratory personnel but not for patients. A variety of unusual growth patterns can occur in uterine leiomyomas, such as diffuse uterine leiomyomatosis, disseminated peritoneal leiomyomatosis, benign metastasizing leiomyoma, parasitic leiomyoma, intravascular leiomyomatosis, dissecting leiomyoma, and leiomyoma with perinodular hydropic degeneration.1 In 1996, Roth et al2 reported a series of 4 cases of leiomyoma characterized … Cystic degeneration is an extreme sequel of edema. Myxoid degeneration in a huge uterine leiomyoma: an unusual benign pathology mimiking malignancy 117 Fig. 3. With minimal discussion in the surgical pathology literature, appropriate evaluation may be challenging because the differential diagnosis includes other uncommon uterine disorders such as intravenous leiomyomatosis, diffuse leiomyomatosis, myxoid … Uterine Leiomyoma: These are the benign tumors of smooth muscle of uterus. Larger tumors result in various pressure symptoms. This is present in a focal form in up to 50% of otherwise typically appearing leiomyomas [ 1 ]. Uterine leiomyomas are commonly referred to as Fibroids. We welcome suggestions or questions about using the website. This is a complication usually occurs in pregnancy. Cotyledonoid dissecting leiomyoma is an extremely rare variant of uterine leiomyoma with an unusual growth pattern characterized by an extrauterine mass that resembles a placenta and histologically shows an intramural dissecting pattern in the uterus [2, 3]. Only five cases have been reported previously. The common cause is due to obstruction of venous drainage at the periphery of the lesion. rajuwilk_ngp@sancharnet.in In the growing knowledge of rare interesting tumors, the cotyledonoid leiomyoma is a tumor with an alarming appearance, of … Intramural: within the myometrium. Obesity, lack of exercise are also risk factors for development of leiomyomas. Microscopically, the nodules were separated by extensive hydropic degeneration. This will result in hyper responsivenesness to normal levels of estrogen in adults. Leiomyoma dissects into myometrium (black 1. 1. Extensive hydropic degeneration in uterine leiomyoma is a rare occurrence and is commonly reported in association with pregnancy. If the tumor is very large, the degenerative changes can be seen. Marked degrees of hydropic degeneration may have resulted in cystic degeneration, leading to large myometrial cysts. 1992 ;16: 26 - 32 . Red Degeneration: This is due to hemorrhagic infaction of a leiomyoma. With minimal discussion in the surgical pathology literature, appropriate evaluation may be challenging because the differential diagnosis includes other uncommon uterine disorders such as intravenous leiomyomatosis, diffuse leiomyomatosis, myxoid … Hydropic changes lead to formation of cystic cavities. They are most common tumors in females. 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