Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2011  |  Volume : 54  |  Issue : 2  |  Page : 413--414

Large ovarian leiomyoma in a postmenopausal woman


A Safaei, M Khanlari, N Azarpira, A Monabati 
 Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Iran

Correspondence Address:
N Azarpira
Department of Pathology, Nemazi Hospital, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz
Iran




How to cite this article:
Safaei A, Khanlari M, Azarpira N, Monabati A. Large ovarian leiomyoma in a postmenopausal woman.Indian J Pathol Microbiol 2011;54:413-414


How to cite this URL:
Safaei A, Khanlari M, Azarpira N, Monabati A. Large ovarian leiomyoma in a postmenopausal woman. Indian J Pathol Microbiol [serial online] 2011 [cited 2020 Jan 27 ];54:413-414
Available from: http://www.ijpmonline.org/text.asp?2011/54/2/413/81598


Full Text

Sir,

Leiomyoma is one of the rarest solid tumors of the ovary that accounts for 0.5-1% of all benign ovarian tumors. Approximately 60 cases are reported in the literature. [1],[2] The majority is small and discovered incidentally, and about 80% of cases occur in premenopausal women. [2],[3],[4],[5] Because of its shortage this tumor is a diagnostic problem and it is confused with other spindle cell tumors of this region such as thecoma-fibroma. Ovarian leiomyoma probably arises from smooth muscle cells in the ovarian hilar blood vessels but other possible origins include cells in the ovarian ligament, smooth muscle cells or multipotential cells in the ovarian stroma, undifferentiated germ cells, or cortical smooth muscle metaplasia. [1],[3],[4]

A 54-year-old postmenopausal multipara woman presented with a history of vaginal discharge and abdominal pain since 5 months. The pelvic examination and transvaginal ultrasonography revealed the presence of left ovarian solid mass. Serum tumor markers (CA125, Ca19-9, and CEA) were within the normal range. An intra-operative frozen section suggested a benign spindle cell tumor such as fibroma/thecoma or leiomyoma. Bilateral salpingo-oophorectomy with hysterectomy was performed. The left ovary was completely replaced by a large, somewhat lobulated mass measuring 16 × 13 × 10 cm. It was extended to the mesovarium and a portion of the broad ligament. The surface of the tumor was smooth, gray, and faintly glistening. There were no adhesions. On cut surface tumor was white-gray in color and displayed a whorled pattern with cystic degenerative changes and slight focal hemorrhage [Figure 1]. Both Fallopian tubes and the uterus were unremarkable. The right ovary was atrophic. Microscopic examination of the tumor showed irregular bundles and whorling of spindle-shaped cells with no atypia or pleomorphism and 1-2 mitotic figures per 10 high-power fields [Figure 2]. An area with various degrees of degenerative changes such as hyaline degeneration and myxomatous changes was also present. There were thick and hyalinized blood vessels. Normal ovarian tissue was not found. The endometrium showed cystic atrophy. Immunohistochemical staining revealed diffuse positive staining for α-smooth muscle actin (SMA) [Figure 3].{Figure 1}{Figure 2}{Figure 3}

Most ovarian leiomyomas are small, measuring only a few millimeters to centimeters in diameter. All tumors of this type are described as being firm round mass and tend to be softer than fibromas. The ovary proper may become completely absorbed by the tumor, as in our case. Frequently, whorling formation is grossly recognizable. Secondary alterations, such as hyalinization, hemorrhage, calcification, edematous change with cyst formation, are present, especially in the larger tumors. [3],[4] The incidence age of ovarian leiomyoma varies between 20 and 65 years. About 16% of cases occur after menopause. [5] They usually present as unilateral, with no predilection for the left or right side. [1],[2] Most bilateral cases were reported in the young age between 16 and 25 years. No bilateral cases have been reported in patients over the age of 35. [1],[2],[5] Meigs' syndrome caused by ovarian leiomyoma with ascitis and/or pleural effusion is an extremely rare event. [5]

The differential diagnosis includes ovarian fibroma-thecoma, cellular fibroma, and sclerosing stromal tumor. [1],[2],[3] Immunohistochemical analysis demonstrated smooth muscle differentiation (immunoreactivity for SMA) which confirms the diagnosis. Ovarian leiomyoma must be also differentiated from leiomyosarcoma. Pathologists have traditionally used criteria that stress the mitotic count, but some other criteria, such as cytological atypia and tumor necrosis, must be mentioned when considering the possibility of malignancy in uterine smooth muscle tumor. [1],[2],[3] Overall, these tumors have a benign course and surgical resection for complete resection is the treatment.

References

1Ramalakshmi Pullela VB, Das S, Chunduru B, Dua S. A case of ovarian leiomyoma with cystic degeneration. Indian J Pathol Microbiol 2009;52:592-4.
2Lerwill MF, Sung R, Oliva E, Prat J, Young RH. Smooth muscle tumors of the ovary: A clinicopathologic study of 54 cases emphasizing prognostic criteria, histologic variants, and differential diagnosis. Am J Surg Pathol 2004;28:1436-51.
3Murakami M, Uehara H, Nishimura M, Iwasa T, Ikawa H. A huge ovarian smooth muscle tumor: A case report. J Med Invest 2010;57:158-62.
4Wei C, Lilic N, Shorter N, Garrow E. Primary ovarian leiomyoma: A rare cause of ovarian tumor in adolescence. J Pediatr Adolesc Gynecol 2008;21:33-6.
5Kurai M, Shiozawa T, Noguchi H, Konishi I. Leiomyoma of the ovary presenting with Meigs' syndrome. J Obstet Gynaecol Res 2005;31:257-62.