Leiomyomas beyond the Uterus: Unusual Locations, Rare Manifestations

Abstract

Uterine leiomyomas affect 20%-30% of women older than 35 years. Extrauterine leiomyomas are rarer, and they present a greater diagnostic challenge: These histologically benign tumors, which originate from smooth muscle cells, usually arise in the genitourinary tract (in the vulva, ovaries, urethra, and urinary bladder) but may arise in nearly any anatomic site. In addition, unusual growth patterns may be seen, including benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal growth. In the presence of such a pattern, a synchronous uterine leiomyoma or a previous hysterectomy for removal of a primary uterine tumor may be indicative of the diagnosis. However, some extrauterine leiomyomas may mimic malignancies, and serious diagnostic errors may result. The most useful modalities for detecting extrauterine leiomyomas are ultrasonography, computed tomography, and magnetic resonance (MR) imaging. The superb contrast resolution and multiplanar capabilities of MR imaging make it particularly valuable for characterizing these tumors, which usually show low signal intensity similar to that of smooth muscle on T2-weighted images. The radiologist's recognition of this and other characteristic features may help steer the clinician toward timely, appropriate management and away from unnecessary, potentially harmful treatment.

Leiomyomatosis Peritonealis Disseminata: A Case Report

“…Microscopically, the round nodules consist of mature fusiform smooth muscle cells and these cells are arranged in interdigitating fascicles [9,10]. The nodules are lack of mitotic figures or the mitotic index (MI) is less than 3/10 high power field (HPF).…”

Atypical leiomyoma: unusual locations and findings coupled with uncommon presentation

“…In addition, unusual growth patterns may be seen, including benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal growth. 2,6 More than 40% of patients affected by this retroperitoneal condition have a concurrent uterine leiomyoma or a remote history of hysterectomy for treatment of a uterine leiomyoma. 5 However, some extrauterine leiomyomas may mimic malignancies, and serious diagnostic errors may result.…”

“…Retroperitoneal leiomyomas, defined as those located posterior to parietal peritoneum, are a very rare occurrence. [1][2][3][4] As of 2007 (1941-2007), only 37 retroperitoneal leiomyomas have been reported in the literature with comprehensive information. There is a need for further research on this condition.…”

“…The most useful modalities for detecting extrauterine leiomyomas are ultrasonography (USG), computed tomography (CT), and magnetic resonance (MRI) imaging. 2 Rarely, the extrauterine masses may extend to the upper retroperitoneum, as high as the level of the renal hilum. They may enlarge considerably yet remain asymptomatic and be detected incidentally at a routine check-up or autopsy.…”

Intravenous low-grade endometrial stromal sarcoma with intracardiac extension: A CASE OF inaccurate tumor location on contrast-enhanced computed tomography

“…It was previously reported that >50% of intravenous LG-ESS cases exhibited ICE (8). In such cases, the extent of the tumor should be determined using modalities such as MRI and ultrasonography, in addition to CT. MRI provides good soft tissue resolution and helps to distinguish an intravascular tumor from a non-tumor thrombus (16)(17)(18), whereas Doppler ultrasonography is also useful (16). Transthoracic ultrasonography of the IVC and heart would normally be performed.…”