Atypical leiomyoma: unusual locations and findings coupled with uncommon presentation
Keywords:Retroperitoneal, Leiomyoma, Laparotomy, Hysterectomy, Immunohistochemistry
AbstractExtrauterine leiomyomas are a rare phenomenon, and they present a great diagnostic challenge. Retroperitoneal leiomyomas remain asymptomatic for a variable period and usually present with wide variety of signs and symptoms. A 51 years old female was multiparous and had undergone a total laparoscopic hysterectomy along with a bilateral salpingo-oophorectomy about four years ago. She visited the outpatient department of a tertiary care hospital complaining of something coming out per vaginum and expressed difficulty in passing urine and also complained of stress urinary incontinence. Bimanual pelvic examination, ultrasonography (USG) and Magnetic resonance imaging (MRI) revealed a large oval shaped well defined solid mass completely filling the vaginal canal while compressing urinary bladder. Tumor marker levels were normal. Laparotomy with adhesiolysis and complete excision of retroperitoneal mass was performed. Frozen section followed by histopathology and immunohistochemistry confirmed that the mass was a leiomyoma. After surgical intervention and removal of mass, the symptoms dissipated and patient had a complete recovery. Despite hysterectomy the manifestation of leiomyoma appears to be apparent. Surgical excision of the mass appeared to be the correct move forward after the leiomyoma was diagnosed with the help of the MRI and the USG.
Mahendru R, Gaba G, Yadav S, Gaba G, Gupta C. A rare case of retroperitoneal leiomyoma. Case reports in surgery. 2012;2012:425280.
Fasih N, Prasad Shanbhogue AK, Macdonald DB, Fraser-Hill MA, Papadatos D, Kielar AZ, et al. Leiomyomas beyond the uterus: unusual locations, rare manifestations. Radiographics : a review publication of the Radiological Society of North America, Inc. 2008;28(7):1931-48.
Kang WD, Kim SM, Kim YH, Choi HS. Three isolated, large retroperitoneal leiomyomas. Archives of gynecology and obstetrics. 2009;280(3):499-501.
Soliman AA, Elsabaa B, Hassan N, Sallam H, Ezzat T. Degenerated huge retroperitoneal leiomyoma presenting with sonographic features mimicking a large uterine leiomyoma in an infertile woman with a history of myomectomy: a case report. Journal of medical case reports. 2011;5:578.
Poliquin V, Victory R, Vilos GA. Epidemiology, presentation, and management of retroperitoneal leiomyomata: systematic literature review and case report. Journal of minimally invasive gynecology. 2008;15(2):152-60.
El-Agwany AS, Fawzy Galal A. An Unusual Case of Retroperitoneal Pelvic Leiomyoma After Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy. Indian Journal of Gynecologic Oncology. 2016;14(1).
Buttram VC, Jr., Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertility and sterility. 1981;36(4):433-45.
Dursun P, Salman MC, Taskiran C, Yuce K, Ayhan A. Retroperitoneal leiomyomatosis: a case report. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society. 2005;15(6):1222-5.
Sewell CA, Russo ML. Retroperitoneal leiomyoma: a case report. The Journal of reproductive medicine. 2011;56(11-12):515-7.
Zaitoon MM. Retroperitoneal parasitic leiomyoma causing unilateral ureteral obstruction. The Journal of urology. 1986;135(1):130-1.
Stutterecker D, Umek W, Tunn R, Sulzbacher I, Kainz C. Leiomyoma in the space of Retzius: a report of 2 cases. American journal of obstetrics and gynecology. 2001;185(1):248-9.
Kho KA, Nezhat C. Parasitic myomas. Obstetrics and gynecology. 2009;114(3):611-5.
Giannella L, Mfuta K, Tuzio A, Cerami LB. Dyspareunia in a Teenager Reveals a Rare Occurrence: Retroperitoneal Cervical Leiomyoma of the Left Pararectal Space. Journal of pediatric and adolescent gynecology. 2016;29(1):e9-11.
Paal E, Miettinen M. Retroperitoneal leiomyomas: a clinicopathologic and immunohistochemical study of 56 cases with a comparison to retroperitoneal leiomyosarcomas. The American journal of surgical pathology. 2001;25(11):1355-63.
Xu Z, Zeng R, Liu J. A large primary retroperitoneal vaginal leiomyosarcoma: a case report. Journal of medical case reports. 2015;9:130.
Desvignes F, Mage G. Laparoscopic management of a pelvic retroperitoneal leiomyoma-case report. Gynecological Surgery. 2011;8(2):247-51.