Recurrent Cotyledonoid Dissecting Leiomyoma of the Uterus

Abstract

Cotyledonoid dissecting leiomyoma is a benign smooth muscle neoplasm with an unusual growth pattern that is characterized by intramural dissection within the uterine corpus and often a placental-like appearance macroscopically in its extrauterine component that may be alarming to the surgeon. All cases reported to date have been nonaggressive. We report a case in a 33-yr-old woman who had a history of prolonged uterine bleeding. She was operated upon for uterine leiomyomas, and the diagnosis of cotyledonoid dissecting leiomyoma was made at the time of intraoperative consultation. To maintain fertility, the intrauterine tumor was resected by myomectomy and the extrauterine tumor by excision. However, persistent uterine bleeding that eventually became intractable and continued growth of the neoplasm in the uterus necessitated hysterectomy 5 yr later. She was living and well 2.5 yr after hysterectomy with no evidence of disease.

A Case Report on Recurrent Cotyledonoid Dissecting Leiomyoma

“…This recurrence was possibly caused by insufficiency of the previous myomectomy. 11 However, in the present study, recurrent myomas after a history of myomectomy were attributed to the susceptibility of cotyledonoid dissecting leiomyoma for recurrence despite its benign histological nature rather than insufficiency of the previous surgery.…”

Cotyledonoid Dissecting Leiomyoma of the Uterus: An Unexpected Diagnosis After Delivery

“…5 Its tendency is to expand beyond the pelvic cavity into the abdomen, namely the adnexal organs, as in our patient, the broad ligaments, the larger abdominopelvic cavity, the retroperitoneum, and the surfaces of the uterine cervix and bladder. 5 A number of variants of CDL have been reported, including cotyledonoid leiomyoma that lacks a detectable intramural component and dissecting leiomyoma that lacks an extrauterine component. 7 Also, the interpretation of vascular involvement in CDL is controversial.…”

“…5 The typical presenting symptoms are abdominal pain, bloating, constipation and weight gain but the most common presentation is abnormal uterine bleeding. 5 CDL is characterized by an exophytic, lobulated, congested, reddish placenta-like mass, 6 as was seen in our case. These leiomyomas tend to arise in the subserosal myometrium, with a dissecting pattern adjacent to the dominant mass.…”

Cotyledonoid dissecting leiomyoma as a possible cause of chronic lower back pain

“…While we recognise the limitation of frozen section in differentiating between benign and malignant smooth muscle tumours of the uterus, in our case, radical surgical resection was required to obtain macroscopic clearance of the disease. In other cases of this disease, a total abdominal hysterectomy and resection of the extrauterine tumour should be performed to avert the low risk of tumour recurrence which has been reported in a single case initially treated more conservatively by myomectomy and extrauterine tumour excision 11. There are however no reported cases of metastases also supporting the benign nature of this variant of leiomyoma.…”