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Year : 2009  |  Volume : 52  |  Issue : 4  |  Page : 592-594
A case of ovarian leiomyoma with cystic degeneration


Department of Pathology, Alluri Seetharamaraju Academy of Medical Sciences, ELURU, W.G.Dt. Andhra Pradesh, India

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Date of Web Publication1-Oct-2009
 

How to cite this article:
Ramalakshmi Pullela V B, Das S, Chunduru B, Dua S. A case of ovarian leiomyoma with cystic degeneration. Indian J Pathol Microbiol 2009;52:592-4

How to cite this URL:
Ramalakshmi Pullela V B, Das S, Chunduru B, Dua S. A case of ovarian leiomyoma with cystic degeneration. Indian J Pathol Microbiol [serial online] 2009 [cited 2019 Aug 25];52:592-4. Available from: http://www.ijpmonline.org/text.asp?2009/52/4/592/56141


Sir,

Leiomyoma arising primarily in the ovary is rare and fewer than 55 examples have been reported. [1],[2] The majority of them are very small and are discovered incidentally. We report one huge ovarian leiomyoma in a 53-year-old lady, clinically and radiologically mimicking mucinous cystadenoma.

A 53-year-old postmenopausal female presented with abdominal pain of two years duration, which increased five months prior to the presentation. There was a 16 - 18 weeks sized mass palpable per abdomen was diagnosed as ovarian cyst . Ultrasonography revealed a huge complex ovarian cyst on right ovary.

Per-operatively, right ovary was enlarged, cystic measuring 15 x 20 cm, extending retroperitoneally but was mobile and not attached to retroperitoneal structures. Bilobed ovarian mass with normal uterus and other ovary was excised [Figure 1]. The larger lobe measured 16 x 10 x 5 cm and smaller lobe measured 12 x 8 x 4 cm. Cut section showed multiple cystic areas with mucoid material and grey white solid whorled areas.

Sections examined from different parts of the tumor showed typical appearance of a leiomyoma [Figure 2] with a rim of ovarian stroma. There were large areas of myxomatous cystic degeneration and hyaline change. No cytological pleomorphism or mitotic figures could be found. There was a small interstitial leiomyoma. The other ovary showed diffuse nodular stromal hyperplasia. Tumor cells were strongly positive for desmin and smooth muscle actin [Figure 3].

The age incidence of ovarian leiomyoma varies between 20 and 65 years . [4] Approximately 16% cases occur after menopause. [4] Most tumors are asymptomatic, some present with a palpable abdominal mass, ascitis or hydronephrosis.

Ovarian leiomyoma is usually unilateral, varies in size, with most displaying a diameter < 3 cm. In the present case the tumor was very large, cystic, resembling mucinous cystadenoma. Kim et al., reported one such case where the leiomyoma was multiloculated, multisepted and mainly cystic. [5]

Several theories have been proposed regarding the histogenesis of the tumors. The most readily accepted explanation is that they arise from the smooth muscle of the ovarian ligaments where they enter the ovary or from the smooth muscle of the ovarian blood vessels. [3] Endometriotic cysts are also suggested to trigger metaplasia of surrounding stroma into smooth muscle cells. [2]

The correct diagnosis of ovarian leiomyoma requires recognition of the smooth muscle nature of the tumor. [1],[3] In the present case smooth muscle actin and desmin positivity was observed [Figure 3].

The differential diagnosis includes ovarian fibroma, thecoma, cellular fibroma and sclerosing stromal tumor. [2] Primary ovarian leiomyoma should also be distinguished from tumors arising from the broad ligament and extending into the hilum of ovary or wandering leiomyoma. [3] The tumor in our case was of ovarian origin because at one end of the tumor there was only a thin rim of residual ovarian tissue and the tube was stretched over the tumor. Coexistence of ovarian leiomyoma with uterine leiomyoma has been reported by several authors. [3] These tumors are benign and may be treated by the least radical surgery that is necessary for their complete removal.

 
   References Top

1.Seidman JD, Russell P, Kurman RJ. Surface epithelial tumors of the ovary. Kurman RJ, editor. Blaustein's pathology of the female genital tract. 5 th ed. New York: Springer-Verlag; 2002. p. 791-904.  Back to cited text no. 1      
2.Erkaya S, Kutlay B, Uygur D, Kra F, Tezer A. Primary ovarian leiomyoma in a postmenopausal woman. Acta Obstet Gynecol scand 2000;79:79-87.  Back to cited text no. 2      
3.Tsalacopoulos G, Tiltman AJ. Leiomyoma of the ovary: A report of 3 cases. S Afr Med J 1991;11:574-6.  Back to cited text no. 3      
4.Fallahzadeh H, Dockerty MB, Lee RA. Leiomyoma of the ovary: Report of 5 cases and review of the literature. Am J Obstet Gynecol 1972;113:394-8.  Back to cited text no. 4      
5.Kim JC, Nam SL, Suh KS. Leiomyoma of ovary mimicking mucinous cystadenoma. Clin Imaging 2000;24:34-7.  Back to cited text no. 5      

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Correspondence Address:
V B Ramalakshmi Pullela
Department of Pathology, Asram Medical College, Eluru.W.G.Dt. Andhra Pradesh -534 004
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.56141

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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