Ruptured degenerated uterine fibroid diagnosed by imaging

Kamat, Nikhil; Telkar, Hemant B.; Ramani, Subhash; Thakker, Ajay P.

doi:10.1016/s0029-7844(01)01541-1

Cited by 20 publications

(16 citation statements)

References 4 publications

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“…The cause of degeneration is unknown. Kamat et al [ 18 ] suggested that cystic degeneration of uterine leiomyomas represents a late stage of hyaline degeneration; however, no hyaline degeneration was observed in our case.…”

Section: Discussioncontrasting

confidence: 78%

Multilocular cystic leiomyoma of the anterolateral abdominal wall

Yorita¹,

Tanaka²,

Hirano³

et al. 2017

Medicine

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Rationale:Leiomyomas arising from the anterolateral abdominal wall are uncommon, and their pathogenesis remains unknown. We present the 15th case of such a tumor, having this unique tumor morphology, followed by a detailed discussion on disease pathogenesis.Patient concerns:A 48-year-old, asymptomatic perimenopausal, multiparous Japanese woman presented with a left-sided pelvic mass. She had no history of previous surgeries or uterine leiomyomas. Although a transabdominal ultrasonogram raised suspicions of an ovarian tumor, a transvaginal ultrasonogram confirmed normal ovaries. Radiological images showed a multilocular cystic mass with enhanced solid lesions connected to the uterus. Retrospective radiological evaluation showed that the mass was largely connected to the peritoneum of the anterolateral abdominal wall.Interventions:Intraoperatively, the mass appeared as a dome-like protrusion from the left lower quadrant of the abdominal wall, without connection to the uterus, ovaries, or the left round ligament. No other peritoneal masses were seen. The mass was easily enucleated from the abdominal wall. Pathology confirmed that the mass was a leiomyoma with hydropic and myxoid degeneration. No striated muscle tissues were noted between the tumor and resection margin, but a thin smooth muscle layer, positive for hormone receptors, was present at the periphery, suggesting the origin of the tumor.Lessons:Benign leiomyomas of the anterolateral abdominal wall likely originate from Müllerian-like smooth muscle remnants in this region. They should be considered in the differential diagnosis of solid and cystic masses and be distinguished from uterine and ovarian masses on imaging to avoid unnecessary organ resection.

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Section: Discussioncontrasting

confidence: 78%

Multilocular cystic leiomyoma of the anterolateral abdominal wall

Yorita¹,

Tanaka²,

Hirano³

et al. 2017

Medicine

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“…Kamat et al . [17] suggested that cystic degeneration of the leiomyoma represents a late stage of hyaline degeneration that could undergo liquefaction; however, no hyaline degeneration was observed in our case. Subserosal pedunculation may affect the blood supply and be associated with the pathogenesis, because the concurrent intramural leiomyoma showed neither cystic nor hydropic degeneration.…”

Section: Discussioncontrasting

confidence: 61%

A subserosal, pedunculated, multilocular uterine leiomyoma with ovarian tumor-like morphology and histological architecture of adenomatoid tumors: a case report and review of the literature

et al. 2016

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BackgroundUterine leiomyomas are common uterine tumors, and typical cases of leiomyoma are easily diagnosed by imaging study. However, uterine leiomyomas are often altered by degenerative changes, which can cause difficulty and confusion in their clinical diagnosis. We describe the 17th reported case of a uterine leiomyoma clinically diagnosed as an ovarian tumor; however, the present case shows the most detailed radiological evaluation, including contrast-enhanced magnetic resonance imaging. We first show that a uterine leiomyoma can histologically mimic an adenomatoid tumor.Case presentationA 47-year-old premenopausal, nulliparous Japanese woman with a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia had lower abdominal pain. Ultrasonography confirmed a 6-cm mass in the right-sided space of the pelvic cavity. Magnetic resonance imaging evaluation showed that a multilocular mass was present near the uterus, and a mucinous ovarian tumor was considered. Emergency surgery due to acute abdomen was performed under the diagnosis of pedicle torsion of the ovarian tumor. During surgery, a pedunculated uterine mass without stalk torsion was seen. 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. Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. The tumor cells were positive for the microphthalmia transcription factor but negative for other melanoma markers. Three days postoperatively, she was discharged without sequelae.ConclusionsMarked intratumoral deposition of fluids may induce the multilocular morphology of a tumor, and the cellular arrangement of the tumor cells with hydropic degeneration mimicked an adenomatoid tumor in this case. Clinicians need to be aware that a subserosal leiomyoma with cystic and hydropic degeneration can mimic an ovarian tumor, and pathologists should be aware that such leiomyomas can mimic adenomatoid tumors. Additionally, perivascular epithelioid cell tumors should not be diagnosed only based on its immunoreactivity for the microphthalmia transcription factor.

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“…However, computed tomography and ultrasound may not be able to delineate the origin of the bleeding [15]. Timely diagnosis and rapid emergent surgical intervention can be life-saving in situations such as the case described.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Rupture of a Leiomyoma Causing Life-Threatening Intra-Abdominal Hemorrhage

Schwartz

Powell

2017

Case Reports in Obstetrics and Gynecology

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Background. Uterine fibroids are common benign tumors in women. Clinical manifestations are well known. Acute complications necessitating emergent surgical intervention are rare. Case. We report a case of a 53-year-old woman with a history of uterine fibroids presenting with acute-onset severe abdominal pain. Imaging indicated massive free fluid and a large partially solid uterine mass. Vitals were consistent with hypovolemic shock. Examination revealed a surgical abdomen. She underwent an emergent laparotomy and total hysterectomy. Surgery revealed 4.5 L of hemoperitoneum and a 15 cm degenerated uterine fibroid with active bleeding. Pathology was consistent with intraoperative findings. She required transfusion of numerous blood products perioperatively. Her postoperative course was uncomplicated. Conclusion. It is rare for a uterine fibroid to spontaneously rupture. However, prompt recognition of this severe complication is critical for expeditious, life-saving surgical management.

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Ruptured degenerated uterine fibroid diagnosed by imaging

Abstract: This is a report of a ruptured degenerated fibroid causing acute abdomen outside of pregnancy. Computed tomography and magnetic resonance imaging aided in correctly establishing the diagnosis and optimizing the management of this patient.

Cited by 20 publications

References 4 publications

Multilocular cystic leiomyoma of the anterolateral abdominal wall

Multilocular cystic leiomyoma of the anterolateral abdominal wall

A subserosal, pedunculated, multilocular uterine leiomyoma with ovarian tumor-like morphology and histological architecture of adenomatoid tumors: a case report and review of the literature

Spontaneous Rupture of a Leiomyoma Causing Life-Threatening Intra-Abdominal Hemorrhage

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