The present case was uncommon in that it exhibited umbilical endometriosis, an extremely enlarged uterus due to marked hydropic and cystic degeneration of the leiomyomas, and torsion of the pedicle of the right ovarian cyst that had caused sudden pain in the right lower abdomen. Apple Green Birefringence. 1. Address correspondence and reprint requests to Dr. Lawrence M. Roth, Department of Pathology, University Hospital, Room 3465, 550 North University Boulevard, Indianapolis, IN 46202-5280, U.S.A. ... and one was a multinodular leiomyoma with hydropic degeneration. Pedunculated: Submucosal and subserosal tumors can be pedunculated with the presence of narrow pedicle. Earlier age of menarche and nulliparous women have higher risk. Ovary tumor - Leiomyoma. There are no clinical findings that reliably differentiate ordinary leiomyomas from leiomyoma variants and leiomyosarcomas. 2b). Pathology When the leiomyomas increase in size, the vascular supply to it becomes inadequate and leads to different types of degeneration which are hyaline, cystic, myxoid, or red degeneration and dystrophic calcification may also occur. These are usually asymptomatic if small and are often incidental finding. They can also interfere in fertility. They also showed an intravascular luminal growth pattern. Reports of leiomyoma with marked cystic degeneration have been relatively uncommon (Aydin et al., 2013). 1992 ;16: 26 - 32 . Saeed et al. Table 1 summarizes ordinary leiomyomas, including their various forms of degeneration, and their main variants. arrow) at the cornu; hydropic change With more than 17 years of experience as an academician, He has developed the art of content generation to make the learning more fun. With minimal discussion in the surgical pathology literature, appropriate evaluation may be challenging because the differential diagnosis includes other uncommon uterine disorders such as intravenous leiomyomatosis, diffuse leiomyomatosis, myxoid … 4. Aims: We present the histopathological findings of a series of six cases of a benign uterine smooth muscle tumour with an unusual growth pattern.. Methods and results: All cases have the appearances of the recently described dissecting (cotyledonoid) leiomyoma.In addition, three of these lesions demonstrate the … A presumed direct relation between the abundance of intratumoral fluid and presence of ascites seemed justified. Uncomplicated leiomyomas are of a heterogeneous echo texture and vary from hypoechoic to hyperechoic, sometimes containing calcifications with acoustic shadowing. Leiomyomas can undergo degeneration, which can result in a variety of sonographic appearances. Occasionally uterine tumors may detach and results in a rare type called PARASITIC leiomyoma. These are usually multiple with sizes ranging from microscopic foci to large bulky tumors. This is present in a focal form in up to 50% of otherwise typically appearing leiomyomas [ 1 ]. Hydropic change is another form of degeneration with a similar MRI appearance, and is due to an accumulation of oedema fluid in the connective tissue of the leiomyoma. 21 year old woman with bilateral massive ovarian leiomyomata (Mod Pathol 1992;5:586) 31 year old woman with primary ovarian leiomyoma associated with endometriotic cyst presenting with symptoms of acute appendicitis (Diagn Pathol 2009;4:25) 79 year old woman with leiomyoma of the ovary presenting with Meigs' syndrome (J Obstet Gynaecol Res … reviewed 20 cases of cotyledonoid dissecting leiomyoma . Loves to promote social media for education in Pathology, Designed by Elegant Themes | Powered by WordPress, ANTICOAGULANTS in Hematologic Investigations, Understanding AZZOPARDI PHENOMENON / EFFECT. This is a complication usually occurs in pregnancy. Am J Surg Pathol. Can cause pressure symptoms due to compression on adjoining structures. Uterine Leiomyoma: These are the benign tumors of smooth muscle of uterus. Cytogenetic abnormalities: 40 to 50% of uterine leiomyomas show karyotypic abnormalities. It is a close mimicker of malignancy due to rapid growth and atypical imaging appearances. 2 The uterus can enlarge and may have a lobulated contour. Hyalinization is the commonest type of degeneration. Magnetic resonance imaging (MRI) was performed to further … Cotyledonoid dissecting leiomyoma is an extremely rare variant of uterine leiomyoma with an unusual growth pattern characterized by an extrauterine mass that resembles a placenta and histologically shows an intramural dissecting pattern in the uterus [2, 3]. Polarizing Microscopy Simplified! Etiology: Exact etiology is not known, however age of menarche and parity are important risk factors. The common cause is due to obstruction of venous drainage at the periphery of the lesion. Red Degeneration: This is due to hemorrhagic infaction of a leiomyoma. Larger tumors result in various pressure symptoms. rajuwilk_ngp@sancharnet.in In the growing knowledge of rare interesting tumors, the cotyledonoid leiomyoma is a tumor with an alarming appearance, of … Submucosal: present benath the endometrium. Abstract. These are the ones which can manifest with menorrhagia. 1. Genes involved : HGMA2, ESR2, RAD5 & MED12, Clinical features: Hydropic changes lead to formation of cystic cavities. Multinodular hydropic leiomyoma (MHL) of the uterus is one of the rarest variants of uterine leiomyomas and can create some diagnostic problems. Posted by Dr Vijay Shankar S | Jan 11, 2021 | Female Genital System & Breast |. Am J Surg Pathol. Highly cellular variant and lipoleiomyomas will be yellowish in color. Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. This is also referred to as Carneous degeneration. is present around smooth muscle bundles No reported case of pseudo-Meigs syndrome presenting with hydropic degeneration of uterine leiomyoma and an elevated CA 125 level could be found on a MEDLINE search. Edematous change, referred to as hydropic degeneration, is a common form of degeneration seen focally in up to 50% of patients with leiomyoma . The most common abnormalities are translocations on chromosome 12; deletion on chromosomes 3q and 7q. Microscopy: the pattern is that of interlacing fascicles or whorling of smooth muscle cells. Marked degrees of hydropic degeneration may have resulted in cystic degeneration, leading to large myometrial cysts. But can manifest with abnormal uterine bleeding which is more common in submucosal leiomyomas. However, we cannot answer medical or research questions or give advice. Occasionally uterine tumors may detach and results in a rare type called PARASITIC leiomyoma. Leiomyomas can occur in any age group but more common in 30 to 50 years. Morphology: Diffuse, perinodular, and other patterns of hydropic degeneration within and adjacent to uterine leiomyomas: problems in differential diagnosis. Increased awareness of this grossly alarming variant of benign uterine leiomyoma can help avoid overtreatment. Cotyledonoid hydropic intravenous leiomyomatosis: a new variant leiomyoma. There are many microscopic variants which include cellular, Leiomyoma with bizzare nuclei, Mitotically active, hydropic, apopletic, lipomatous, epithelioid, myxoid, dissecting leiomyomas etc. Diffuse hydropic degeneration is considered much less common and may result in exceptionally large tumors, depending on the degree of fluid accumulation . Author information: (1)Department of Pathology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur. We describe a case of a 35-year-old woman with a pedunculated uterine leiomyoma with diffuse hydropic degeneration presenting as a giant abdominal mass. Obesity, lack of exercise are also risk factors for development of leiomyomas. This will result in hyper responsivenesness to normal levels of estrogen in adults. 1) was described and distinguished from the interstitial hyaline degeneration that is commonly seen in uterine leiomyomata. Cystic change, an extreme form of hydropic degeneration is a rare clinical presentation. Background: Leiomyomas rarely cause pseudo-Meigs syndrome. Microscopically, the nodules were separated by extensive hydropic degeneration. Geographic areas of hydropic degeneration were identified (Fig. Cotyledonoid leiomyoma apparently results from a combination of several uncommon growth patterns operating together, including subserosal growth, dissecting growth, and perinodular hydropic degeneration. The tumor cells were positive for the microphthalmia transcription factor but negative for other melanoma markers. Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. A variety of unusual growth patterns can occur in uterine leiomyomas, such as diffuse uterine leiomyomatosis, disseminated peritoneal leiomyomatosis, benign metastasizing leiomyoma, parasitic leiomyoma, intravascular leiomyomatosis, dissecting leiomyoma, and leiomyoma with perinodular hydropic degeneration.1 In 1996, Roth et al2 reported a series of 4 cases of leiomyoma characterized … Myxoid degeneration in a huge uterine leiomyoma: an unusual benign pathology mimiking malignancy 117 Fig. Gross: The cut surfaces are well circumscribed, with greywhite and whorled cut surface. The tumor is diagnosed histologically by a pathologist by observing a tumor … The mass grossly contained serous and hemorrhagic fluids in the cavities, and pathology examination confirmed that the mass was a leiomyoma with hydropic and cystic degeneration. Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. They are most common tumors in females. A leiomyoma is a benign smooth muscle tumor that can develop anywhere in the body Hydropic Leiomyoma of Uterine Corpus is an uncommon morphological variant of Uterine Corpus Leiomyoma. pathology examination confirmed that the mass was a leiomyoma with hydropic and cystic degeneration. Leiomyoma dissects into myometrium (black Hyaline degeneration consisting of nodular confluent acellular areas (Fig. The mass grossly contained serous and hemorrhagic fluids in the cavities, and pathology examination confirmed that the mass was a leiomyoma with hydropic and cystic degeneration. The individual smooth muscle cells are uniform in size and shape and have characteristic oval to elongated with blunt ends ( CIGAR shaped). © Copyright PathologyOutlines.com, Inc. Click, Also called dissecting cotyledonoid leiomyoma, Sternberg tumor (, Rare benign tumor characterized by extrauterine bulbous growth continuous with a dissecting myometrial component, Dissecting leiomyomas rarely are due to noncotyledonoid variants (, 55 year old woman whose tumor had alarming gross appearance (, 63 year old woman with epithelioid variant (, Multinodular, exophytic congested bulky tumor resembling placenta extends from uterine wall into broad ligament and pelvic cavity, Reddish brown with multiple bulbous processes protruding over uterine surface, Fascicles and nodules of bland smooth muscle cells, prominent hydropic degeneration, No necrosis, no mitotic figures and no atypia. Ultrasonography (US) showed a heterogeneous abdominopelvic mass. Pathology confirmed that the mass was a leiomyoma with hydropic and myxoid degeneration. Leiomyomas with hydropic change do not have thick smooth muscle cells fascicles but a delicate filigree pattern with oedema fluid as extracellular material [1]. Most often asymptomatic. Increased levels of CA 125 often are associated with some types of malignancy. Subserosal they are seen beneath the serosa. The common cause is due to obstruction of venous drainage at the periphery of the lesion. Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. 2. Hydropic degenerating leiomyomas are characterized by focal accumulation of edema and collagen deposition. Hydropic degeneration of uterine leiomyoma mimicking a huge ovarian cyst Ifeyinwa Mary Asuzu, Emmanuel Ugwa, Kevin Nwabueze Ezike ABSTRACT Introduction: Leiomyomas are very common neoplasms of the female genital tract. Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. Leiomyoma dissects into myometrium (black arrow) at the cornu; hydropic change is present around smooth muscle bundles (perinodular hydropic degeneration) The incidence decreases after menopause. 2) and distinguished from the interstitial edema commonly seen in leiomyomata. Intramural: within the myometrium. This is a complication usually occurs in pregnancy. If the tumor is very large, the degenerative changes can be seen. We welcome suggestions or questions about using the website. Based on the location of the tumor they are categorized as The patient was admitted in the emergency department because of diffuse abdominal bloating and discomfort. The nodules were composed of cigar-shaped spindle cells with no mitosis, cellular pleomorphism or coagulation necrosis. Most important risk factor is exposure to environmental estrogens before puberty. In the acute test, group 1 showed a sharply demarcated area of coagulative necrosis that did not express estrogen receptor (ER) or progesterone receptor (PR); group 2 showed a severe hydropic degeneration or necrosis; and group 3 showed regular leiomyoma cells. Uterine leiomyomas are commonly referred to as Fibroids. (perinodular hydropic degeneration), 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA). Huge leiomyoma with myxoid degeneration (cystic spaces) on cut section Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. Cystic degeneration is an extreme sequel of edema. This website is intended for pathologists and laboratory personnel but not for patients. leiomyoma might have a unique clinical presentation involving concomitant uterine adenomyosis. Only five cases have been reported previously. Red Degeneration: This is due to hemorrhagic infaction of a leiomyoma. Hydropic degeneration is characterized by accumulation of oedema fluid with associated collagen deposition presenting with various patterns [5], [6]. It is critical for ... 1Department of Pathology, KKR Sapporo Medical Center, 6-3–40, Ichijyo, Hiragishi, Toyohira-ku, Sapporo, Hokkaido 062-0931, Japan ... marked hyalinized degeneration and hydropic change (Fig. Specifically, a rapidly growing uterine mass is not a reliable predictor of leiomyosarcoma according to Parker et al. With minimal discussion in the surgical pathology literature, appropriate evaluation may be challenging because the differential diagnosis includes other uncommon uterine disorders such as intravenous leiomyomatosis, diffuse leiomyomatosis, myxoid … The cytoplasm s abundant and eosinophilic with elongated bipolar processes. Extensive hydropic degeneration in uterine leiomyoma is a rare occurrence and is commonly reported in association with pregnancy. They can be single or multiple. 3. 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