Atypical Uterine Leiomyoma: A Case Report and Literature Review
Main Article Content
Abstract
Introduction: Atypical leiomyomas are diagnosed histologically, showing pleomorphic atypical tumor cells with low mitotic counts and no coagulative necrosis. Surgical treatment is indicated when abnormal uterine bleeding or symptoms related to the size of the leiomyomas, infertility, or recurrent gestational loss are presented.
Clinical case: A 40-year-old woman with a history of menstrual changes, abdominal pain, and intermenstrual bleeding was scheduled for surgery. Pathology reported an atypical leiomyoma (23x18x13 cm) with myxoid degeneration.
Discussion: Uterine leiomyomas affect 70-80% of women in their reproductive age. Symptoms vary by size and location, including abnormal bleeding, pain, and pressure-related issues. This patient had a single pedunculated leiomyoma, no endometrial hyperplasia, negative cervical cytology, and uterine adhesions. Myomectomy was chosen to avoid organ damage.
Conclusion: Atypical leiomyomas are rare tumors diagnosed through biopsy and histopathological examination, displaying 10 mitoses per field and no necrosis. Immunohistochemical studies are necessary to distinguish them from leiomyosarcoma. Long-term follow-up after myomectomy is essential to monitor for recurrence.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Giuliani, E., As-Sanie, S., & Marsh, E. E. (2020). Epidemiology and management of uterine fibroids. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 149(1), 3–9. https://doi.org/10.1002/ijgo.13102
II. Hernández-Valencia, M, Valerio-Castro, E, Tercero-Valdez-Zúñiga, CL, Barrón-Vallejo, J, & Luna-Rojas, RM. (2017). Miomatosis uterina: implicaciones en salud reproductiva. Ginecología y obstetricia de México, 85(9), 611-633. http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0300-90412017000900611&lng=es&tlng=es.
III. Ginecología y Obstetricia de México (Vol. 91, Número 3). (2023). Nieto Editores. (Fitch K, Rojas J, Zamora J, Vázquez A, Sepúlveda J. Leiomioma uterino gigante en adolescente mexicana de 14 años, un caso raro de sangrado uterino anormal. Reporte de caso. Ginecol Obstet Mex 2023; 91 (7): 521-526.
IV. Moroni, R. M., Vieira, C. S., Ferriani, R. A., dos Reis, R. M., Nogueira, A. A., & Brito, L. G. O. (2015). Presentation and treatment of uterine leiomyoma in adolescence: a systematic review. BMC Women’s Health, 15(1).
https://doi.org/10.1186/s12905-015-0162-9
V. Jhonatan, R., Luis, S. D., Loretta, D. G., David, M., & Carlos, D. P. (2013). Leiomioma uterino atípico. Retrieved September 15, 2024, from
https://www.imbiomed.com.mx/articulo.php?id=91925
VI. Bell, S. W., Kempson, R. L., & Hendrickson, M. R. (1994). Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. The American Journal of Surgical Pathology, 18(6). https://pubmed.ncbi.nlm.nih.gov/8179071/
VII. Manxhuka-Kerliu, S., Kerliu-Saliu, I., Sahatciu-Meka, V., Kerliu, L., & Shahini, L. (2016). Atypical uterine leiomyoma: a case report and review of the literature. Journal of Medical Case Reports, 10(1). https://doi.org/10.1186/s13256-016-0800-3
VIII. Prayson, R. A., & Hart, W. R. (1995). Pathologic considerations of uterine smooth muscle tumors. Obstetrics and Gynecology Clinics of North America, 22(4).
https://pubmed.ncbi.nlm.nih.gov/8786875/
IX. Ubago, J. M., Zhang, Q., Kim, J. J., Kong, B., & Wei, J.-J. (2016). Two subtypes of atypical leiomyoma: Clinical, histologic, and molecular analysis. The American Journal of Surgical Pathology, 40(7), 923–933.
https://doi.org/10.1097/pas.0000000000000646
X. Mills, A. M., Ly, A., Balzer, B. L., Hendrickson, M. R., Kempson, R. L., McKenney, J. K., & Longacre, T. A. (2013). Cell cycle regulatory markers in uterine atypical leiomyoma and leiomyosarcoma: Immunohistochemical study of 68 cases with clinical follow-up. The American Journal of Surgical Pathology, 37(5), 634–642.
https://doi.org/10.1097/pas.0b013e318287779c
XI. Wei, J.-J. (2022). Leiomyoma with nuclear atypia: Rare diseases that present a common diagnostic problem. Seminars in Diagnostic Pathology, 39(3), 187–200. https://doi.org/10.1053/j.semdp.2022.01.006
XII. Huete G, Á., Craig, J., V., Vial A, M. C., Farías J, M., Tsunekawa, H., & Cuello F, M. (2019). Rol de la imagenología en el proceso diagnóstico de la patología ginecológica benigna.
https://revistaschilenas.uchile.cl/handle/2250/68534
XIII. Cejas, C., Binda, M. del C., Bordegaray, S., Domljanovic, I., & Russo, L. (2007). ¿Qué nos aporta la RM en la patología uterina? Revista Argentina de Radiología / Argentinian Journal of Radiology, 71(2),183–195. https://www.redalyc.org/articulo.oa?id=382538451007