More to be Learned about Cotyledonoid Dissecting Leiomyoma

Introduction

Cotyledonoid dissecting leiomyoma, also known as a “grape-like” myoma or Sternberg tumor, is a particularly uncommon variant of uterine fibroma that imitates malignant gross characteristics; however this tumor is a benign neoplasm clinically and pathologically. The name cotyledonoid leiomyoma originates from the characteristic macroscopic appearance, which includes extrauterine dark red-brown, spongy, bulbous, exophytic masses, resembling the maternal face of the placenta [Smith CC et al. Int J Surg Pathol 2012; 20: 330–341].

Clinically, most cases occur in women of reproductive age, presenting abnormal uterine bleeding and symptoms related to the presence of a pelvic mass. Preoperative diagnosis either by 2D ultrasound or magnetic resonance images (MRI) is usually inaccurate and very frequently raises the suspicion for a malignant process [Raga F et al. Cotyledonoid dissecting leiomyoma of the uterus. Fertil Steril 2009; 91: 1269–1270].

Although this tumor is a benign neoplasm, gross appearance and unusual growth pattern may mimic a malignant process. Consequently, to avoid aggressive surgery it is essential to recognize it preoperatively.