Cotyledonoid dissecting leiomyoma of the uterus with intravascular growth in postmenopausal woman: a case presentation

Gezginç, Kazım; Yazıcı, Fatma; Selimoğlu, Refika; Tavlı, Lema

doi:10.1007/s10147-011-0184-8

Cited by 10 publications

(15 citation statements)

References 15 publications

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“…In the case that the frozen section indicates a benign tumor, a myomectomy may be considered for young women, particularly for patients that want to preserve fertility. According to the age of the patients, the requirement to bear children and the involvement of the disease, the following surgical methods are always considered, at present (1,5,6,(12)(13)(14)(15)(16). For older patients that do not express the desire to bear children, a total hysterectomy may be the most appropriate treatment, as demonstrated by the third and fourth cases in the present study.…”

Section: Discussionmentioning

confidence: 81%

“…In the literature, to preserve fertility, the recommended treatment is resection of intrauterine tumors by myomectomy and extrauterine tumors by excision (1,5,12,13). In women of postmenopausal stage, total abdominal hysterectomy and bilateral salpingo-oophorectomy are recommended with removal of parametrically extended tumors (6,(14)(15)(16). No standard treatment for CDL has been identified; however, the prognosis of CDL is favorable.…”

Section: Introductionmentioning

confidence: 99%

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Cotyledonoid dissecting leiomyoma of the uterus: A report of four cases and a review of the literature

Yang

et al. 2016

Oncology Letters

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Abstract. Cotyledonoid dissecting leiomyoma (CDL), also termed Sternberg tumor, is a variant of uterine leiomyoma that is rarely diagnosed by clinical evaluation. At present, ~43 cases of CDL have been reported in the literature written in the English language. Due to the distinctive grapelike gross appearance of an exophytic mass resembles placental tissue, CDL is often misdiagnosed clinically as an ovarian tumor or uterine sarcoma. Therefore, an awareness of the features of the disease is important to prevent misdiagnosis and overtreatment. The present study reports 4 cases of CDL of the uterus that were treated at the Second Hospital of Jilin University between January 2009 and December 2011. All 4 patients in the current study presented with a palpable asymptomatic pelvic mass, which was detected during physical examinations, and cancer antigen 125 tumor marker levels that were within the normal range. The exploratory laparotomy of the 4 patients revealed lobulated tumors with a grapelike appearance extending from the lateral uterine wall into the ligament or the adjacent tissues. The frozen section and postoperative pathology were diagnosed as CDL. A total abdominal hysterectomy was performed in the first case of a 55-year-old woman that had been in menopause for 7 years. The patient was well and showed no evidence of disease subsequent to 48 months of follow-up. A total abdominal hysterectomy and right salpingo-oophorectomy were performed in the second case of a 43-year-old woman, who was well and showed no evidence of disease subsequent to 26 months of follow-up. A subtotal abdominal hysterectomy and bilateral salpingectomy were performed in the third case of a 37-year-old woman, who was well and showed no evidence of disease subsequent to 27 months of follow-up. A total abdominal hysterectomy and right-salpingectomy were performed with the removal of a retroperitoneal fibroid extension in the fourth case of a 48-year-old woman, who was well and showed no evidence of disease subsequent to 32 months of follow-up.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Cotyledonoid dissecting leiomyoma of the uterus: A report of four cases and a review of the literature

Yang

et al. 2016

Oncology Letters

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“…leiomyosarcomas), can be easily excluded after microscopic observation. 1 , 4 Microscopic differential diagnoses included intravascular leiomyomatosis, disseminated peritoneal leiomyomatosis, and benign metastasizing leiomyoma. Intravascular leiomyomatosis is characterized by a grossly visible vascular invasion of a histologically proven benign smooth muscle tumor.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 Intravascular growth is rare, and only 9 cases (21.4%) have been reported in the 42 published cases of CDLs, which includes the present case. 1 , 4 , 7 - 9 Foci of intravascular luminal growth pattern may cause misdiagnosis of the condition as a malignancy when present. Intravenous leiomyomatosis behaves in a benign fashion although vascular invasion may extend as far as the extrauterine pelvic veins, the inferior vena cava, and even up to the right side of the heart.…”

Section: Discussionmentioning

confidence: 99%

Cotyledonoid Dissecting Leiomyoma of the Uterus with Intravascular Luminal Growth: A Case Study

2013

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Here, we report the case of a 43-year-old female who was diagnosed with a cotyledonoid dissecting leiomyoma (CDL) of the uterus. CDL is a recently described and extremely rare variant of a benign leiomyoma that can grossly masquerade as a malignancy. The 13-cm sized tumor was located primarily on the extrauterine surface as an intrauterine continuity, which showed dark red, congested, bulbous protuberances. It was multinodular appearance, encasing the bilateral adnexae and the left iliac vein. Microscopically, the nodules were separated by extensive hydropic degeneration. The nodules were composed of cigar-shaped spindle cells with no mitosis, cellular pleomorphism or coagulation necrosis. They also showed an intravascular luminal growth pattern. CDL with intravascular growth was diagnosed after excluding intravascular leiomyomatosis, disseminated peritoneal leiomyomatosis, and benign metastasizing leiomyoma. The present case is the second reported case of CDL in Korea. Recognition of this rare and bizarre, malignancy-mimicking leiomyoma is crucial to prevent inappropriate treatment.

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“…Cotyledonoid dissecting leiomyoma (CDL) is a distinctive variant of dissecting leiomyoma that is characterized by a reddish, exophytic, placenta-like gross appearance and by its frequent extrauterine extension into the adjacent tissues and the pelvic cavity. 5-33 CDL was originally described as “grapelike leiomyoma” by David et al 5 in 1975 and as “proliferating pelvic angioleiomyomatosis (red seaweed lesion)” by Sternberg 6 in 1979. Sternberg tumor and CDL (the latter based on its placental-like appearance) are both appellations that were initially applied by Roth et al 7 in their 1996 report of 4 cases that formally defined the lesion as a distinct clinicopathological entity.…”

Section: Introductionmentioning

confidence: 99%

Cotyledonoid Dissecting Leiomyoma of the Uterus

et al. 2012

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Cotyledonoid dissecting leiomyoma is a rare benign uterine tumor whose gross and radiological appearance may raise the possibility of a malignancy. The authors summarize herein the clinical, radiological, and pathological features of the 41 previously reported cases. The patients typically presented with menorrhagia or symptoms that were ultimately relatable to the presence of a pelvic mass. The median patient age was 46 years (range 23-73). The average tumor size was 15.4 cm (range 4-41); most were exophytic, multinodular, occasionally cystic masses with a congested, spleen or placenta-like color, protruding over the uterine serosa and, variably, the broad ligaments and adjacent organs. In most cases, the exophytic component was contiguous with the intramural dissecting leiomyomatous components. Histological features suggestive of malignancy, such as cytological atypia, necrosis, or increased mitotic activity were absent. Intravascular growth, as assessed histologically, was present in 20% of reported cases, and this finding is apparently devoid of clinical significance based on limited data. Reported information on radiological features is limited. However, these lesions are typically isointense to myometrium on T1-weighted MRI and are in general less heterogeneous on T2 and postcontrast-imaging than sarcomatous lesions. The tumor may display extension to but not frank invasion of surrounding organs. Ultrasound features are nonspecific. Follow-up information was available in 25 (61%) of 41 reported patients: none experienced a tumor recurrence or metastases during the follow-up period, which ranged from 1 month to 41 years. This affirms the benign nature of this tumor, its alarming gross appearance and growth patterns notwithstanding.

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Cotyledonoid dissecting leiomyoma of the uterus with intravascular growth in postmenopausal woman: a case presentation

Cited by 10 publications

References 15 publications

Cotyledonoid dissecting leiomyoma of the uterus: A report of four cases and a review of the literature

Cotyledonoid dissecting leiomyoma of the uterus: A report of four cases and a review of the literature

Cotyledonoid Dissecting Leiomyoma of the Uterus with Intravascular Luminal Growth: A Case Study

Cotyledonoid Dissecting Leiomyoma of the Uterus

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