Cotyledonoid Dissecting Leiomyoma with Symplastic Features: Case Report

Abstract

Purpose Cotyledonoid dissecting leiomyoma is a leiomyoma variant exhibiting unusual growth patterns. We aimed to demonstrate this, as well as to point out another feature that has not been previously reported.

Case Report A congested, multinodular myomectomy specimen was resected. Histologically, smooth muscle fascicles with marked vascularity and extensive hydropic degeneration were detected. A total of 2 mitoses per 10 high power fields were counted, and the K_i-67 index was of 2–3%. We encountered atypical bizarre cells that have not been previously reported. Coagulative necrosis was not present. The patient was alive and well 36 months after surgery, with no evidence of recurrence.

Conclusions Albeit the gross aggressive appearance, cotyledonoid dissecting leiomyomas are benign in nature. To this day, atypical cells have not been reported in this type of tumor. Despite the presence of symplastic features, cotyledonoid dissecting leiomyomas are clinically benign entities. Surgeons and pathologists should be acquainted with this variant.

Resumo

Introdução O leiomioma dissecante na forma cotiledonoide é uma variante de leiomioma com padrões raros de crescimento. Além de demonstrá-los, vamos apontar outro aspecto anteriormente não relatado.

Relato de Caso Uma amostra congestionada, multinodular de miomectomia foi excisada. Histologicamente, detectaram-se fascículos de músculos lisos com marcada vascularidade e extensa degeneração hidrópica. Contaram-se 2 mitoses por 10 campos de alta potência, e o índice K_i-67 foi de 2–3%. Encontramos células atípicas, bizarras, que não haviam sido relatadas anteriormente. Não foi observada necrose coagulativa. A paciente encontrava-se saudável e sem evidências de recorrência 36 meses após a cirurgia.

Conclusão De aparência bruta e grosseira, os leiomiomas dissecantes na forma cotiledonoide têm natureza benigna. Até hoje, células atípicas não haviam sido relatadas nesse tipo de tumor. Apesar dos aspectos simplásticos, os leiomiomas dissecantes na forma cotiledonoide são entidades clínicas benignas. Cirurgiões e patologistas devem estar familiarizados com essa variante.

Keywords

benign - cotyledonoid - leiomyoma - symplastic

Palavras-chave

benigno - cotiledonoide - leiomioma - simplástico

• References

• 1 Ersöz S, Turgutalp H, Mungan S, Güvendı G, Güven S. Cotyledonoid leiomyoma of uterus: a case report. Turk Patoloji Derg 2011; 27 (03) 257-260
• 2 Roth LM, Reed RJ, Sternberg WH. Cotyledonoid dissecting leiomyoma of the uterus. The Sternberg tumor. Am J Surg Pathol 1996; 20 (12) 1455-1461
• 3 Kim MJ, Park YK, Cho JH. Cotyledonoid dissecting leiomyoma of the uterus: a case report and review of the literature. J Korean Med Sci 2002; 17 (06) 840-844
• 4 Weissferdt A, Maheshwari MB, Downey GP, Rollason TP, Ganesan R. Cotyledonoid dissecting leiomyoma of the uterus: a case report. Diagn Pathol 2007; 2: 18
• 5 Menolascino-Bratta F, García de Barriola V, Naranjo de Gómez M, García Tamayo J, Suarez JA, Hernández Chacón AV. Cotyledonoid dissecting leiomyoma (Sternberg tumor): an unusual form of leiomyoma. Pathol Res Pract 1999; 195 (06) 435-438 , discussion 439
• 6 Smith CC, Gold MA, Wile G, Fadare O. Cotyledonoid dissecting leiomyoma of the uterus: a review of clinical, pathological, and radiological features. Int J Surg Pathol 2012; 20 (04) 330-341
• 7 Fox H, Wells M. Haines & Taylor Obstetrical and Gynaecological Pathology. 5th ed. London: Churchill Livingstone; 2003
• 8 Nucci MR, Oliva E. Gynecological Pathology: A Volume in the Series Foundations in Diagnostic Pathology. London: Churchill Livingston; 2009