Retroperitoneal leiomyoma of the uterus mimicking sarcoma in perimenopausal woman: case report

Giant Fibroid Mimicking a Gastrointestinal Stromal Tumor: A Diagnostic Dilemma

Uterine fibroids are the most common benign pelvic tumors in females of the reproductive age group. Usually, fibroids are confined to the uterus. Here, we report an interesting and rare case of a large 17 cm abdominopelvic mass lesion that led to a diagnostic dilemma between a mesenteric gastrointestinal stromal tumor (GIST) and a uterine fibroid. We had a 26-year-old female who underwent an ultrasound examination of the abdomen as the initial imaging modality and was found to have an abnormally large solid abdominopelvic mass lesion. For further evaluation, a contrast-enhanced CT examination of the abdomen-pelvis was done. Initially, on first look, the mass was thought to be of mesenteric origin, but on further review of images, it was found to be of gynecological origin. Intraoperatively, the solid mass was seen attached to the uterine fundus and underwent excision. Histopathological examination confirmed the mass to be a uterine fibroid. This case study describes the uncommon appearance of this tumor in a young woman, including the clinical presentation, imaging, and surgical findings.

Leiomyoma cellulare in the broad ligament of the uterus

There are only two reports on leiomyoma cellulare (LC) in the parametrium that have been published so far. Aim of the study was analysis of two cases of LC in the parametrium diagnosed postoperatively, and review of literature on the subject. Case 1: A 50-year-old patient was operated on for LC located in the right parametrium and concomitant malignant tumour in the right ovary. Leiomyoma cellulare was resected, hysterectomy and bilateral appendectomy performed, and bilateral iliac and obturator lymph nodes excised. Case 2: A 46-year-old patient was operated on for giant LC, on the left side, reaching the retroperitoneal space in the meso- and epigastrium. Leiomyoma cellulare was resected, and hysterectomy and bilateral appendectomy performed. The patient was reoperated twice due to haemorrhage within 24 hours following the operation. A literature review found reports on two cases of LC in 29- and 50-year-old patients with LC in the parametrium, located on the right and left side, respectively. Casuistic location of LC in the parametrium justifies reporting the cases in the literature. Preoperative diagnosis of LC in the parametrium is difficult. Conservative treatment, i.e. myomectomy should be reserved for those patients who wish to maintain fertility.

Uterine Lipoleiomyoma in Peri or Postmenopausal Women

Lipoleiomyoma is an uncommon neoplasm of the uterus, composed of smooth muscles intermixed with mature adipocytes. These tumors are considered a benign variant of uterine leiomyomas. Herein, we report six cases of lipoleiomyoma experienced in our institution from January 2005 to March 2015. The patients ranged in age from 45 to 70 years; the etiology may be related to estrogen deficiency occurring after menopausal transition. Except for one lipoleiomyoma in the broad ligament, all others were found in the uterine corpus. The presenting symptoms were nonspecific, and most cases were incidentally diagnosed during surgery for other reasons. We performed preoperative imaging studies, including abdominal and pelvic computed tomography and magnetic resonance imaging. Preoperatively, four patients were diagnosed as having a pelvic mass and one patient was diagnosed as having a right ovarian mature teratoma. In one case, we found a gynecologic malignancy (cervical cancer 1A1). Histologically, there was no gross or microscopic contiguity between the lipoleiomyoma and the malignancy. Lipoleiomyomas seem to have a benign clinical course. In our study, there were no recurrences of or deaths attributed to the lipoleiomyomas during a mean follow-up period of 16.17 ± 23.80 months.