Indian Journal of Pathology and Microbiology

IMAGES
Year
: 2012  |  Volume : 55  |  Issue : 4  |  Page : 585--586

Diffuse leiomyomatosis of the uterus diagnosed during pregnancy with successful vaginal delivery


Kiran Agarwal, Neha Kawatra Madan, Meenu Pujani 
 Department of Pathology, Lady Hardinge Medical College, New Delhi, India

Correspondence Address:
Neha Kawatra Madan
64 B - Mian Wali Colony, Gurgaon, Haryana
India




How to cite this article:
Agarwal K, Madan NK, Pujani M. Diffuse leiomyomatosis of the uterus diagnosed during pregnancy with successful vaginal delivery.Indian J Pathol Microbiol 2012;55:585-586


How to cite this URL:
Agarwal K, Madan NK, Pujani M. Diffuse leiomyomatosis of the uterus diagnosed during pregnancy with successful vaginal delivery. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Oct 22 ];55:585-586
Available from: https://www.ijpmonline.org/text.asp?2012/55/4/585/107836


Full Text

Diffuse uterine leiomyomatosis (DUL) is a benign and extremely rare condition in which the uterus is symmetrically enlarged as a result of almost complete replacement of the myometrium by innumerable poorly defined, confluent leiomyomatous nodules. [1] To the best of our knowledge, about 45 sporadic cases have been reported in the English literature. It usually affects women of reproductive age group who present with abdominal pain and vaginal bleeding. Other symptoms include menorrhagia, dysmenorrhea, infertility, and pelvic pressure. The exact etiology of this condition is not clearly understood. Earlier, it was believed that the spindle cells of all small myomas had a clonal origin. However, later studies suggested that diffuse uterine leiomyomatosis may be an exuberant example of diffuse and uniform involvement of the entire myometrium by multiple leiomyomata. [2]

Few cases of successful pregnancies have been reported in the past in association with DUL, and almost all these cases were following hysteroscopic management or uterine artery embolization. [3] Here, we report a case of diffuse leiomyomatosis in a 38-year-old woman diagnosed during pregnancy.

A 38-year-old gravida 2, para 2, with one live issue, was referred to the Obstetric Out Patient Department (OPD) at three-month period of gestation from a primary health center in North India. The patient was thin built, hemoglobin was 9gm%, and fundal height was 20 weeks. Ultrasonographic examination revealed a single live fetus in a large uterus that had multiple myomas each with a diameter of <3 cm. The subsequent antenatal course was uneventful. At full term, the patient vaginally delivered a healthy infant weighing 2.5 kg. During the third stage of labor, she developed atonic postpartum hemorrhage and subtotal hysterectomy was performed. Gross specimen consisted of a gravid uterus measuring 20 × 18 × 14 cm that weighed 1.9 kg. Myometrial thickness varied from 4 cm to 7 cm and showed numerous small fibroids intermingled together [Figure 1]. On microscopic examination, the nodules were composed of fascicles of benign spindle-shaped smooth muscle cells [Figure 2]a. The nodules blended with each other and merged imperceptibly with the surrounding normal myometrium. On immunohistochemistry, these smooth muscle cells were strongly positive for smooth muscle actin [Figure 2]b, desmin, vimentin, and weakly for CD 10. A diagnosis of gravid uterus showing diffuse uterine leiomyomatosis was made. The patient was discharged on the seventh postoperative day.{Figure 1}{Figure 2}

This implies that successful pregnancies can occur in such a case. Since no previous such case has been reported, further study in this regard is needed.

References

1Clement PB. The pathology of uterine smooth muscle tumors and mixed endometrial stromal-smooth muscle tumors: A selective review with emphasis on recent advances. Int J Gynecol Pathol 2000;19 : 39-55.
2Baschinsky DY, Isa A, Niemann TH, Prior TW, Lucas JG, Frankel WL. Diffuse leiomyomatosis of the uterus: A case report with clonality analysis. Hum Pathol 2000;31:1429-32.
3Yen CF, Lee CL, Wang CJ, Soong YK, Arici A. Successful pregnancies in women with diffuse uterine leiomyomatosis after hysteroscopic management. Fertil Steril 2007;88:1667-73.