Cotyledonoid Dissecting Leiomyoma of the Uterus with Intravascular Luminal Growth: A Case Study
A 43-year-old Korean female (gravida 2, para 2) with a three-year history of a palpable abdominal mass was admitted to the gynecology outpatient department. She had a history of two caesarian sections. The patient had been followed up for 12 months. A recent evaluation showed a marked increase in tumor size (up to approximately 8.0 cm) and the presence of abdominal pain. Abdominopelvic computed tomography showed a large enhancing mass measuring 13.0 cm that encased the left adnexa, the uterus, and the left iliac vein (). Omental haziness and small seeding nodules suggested the possibility of seeding carcinomatosis peritonei. Intraoperatively, no collection of pelvic cavity fluid was found. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed with removal of the parametrially extended tumor. Grossly, the multinodular mass was dark red, congested and spongy with bulbous protuberances over the extrauterine surface and bilateral broad ligaments (). Contrary to the dark red color of the external surface, the cut surface showed a homogeneous, grayish tan-colored, multinodular, firm trabeculated appearance (). No intravascular growth or invasion was identified on gross examination. Leiomyosarcoma was initially suspected. Microscopically, the excised mass was composed of variably sized multiple nodules, which were surrounded by perinoudular widened hydropic degeneration (). The nodules consisted of fascicles of spindle cells with no cellular pleomorphism, mitotic activity, or coagulation necrosis (). The mass encased the bilateral ovaries and salpinges, which were free from tumor invasion. Intravascular protruding growth was also found (). Immunostaining for CD34 highlighted the endothelial cells of the blood vessels surrounding the foci of the intravascular growth of the leiomyoma (). The spindle cells were positive for muscle-specific actin (IA4, prediluted, Dako, Glostrup, Denmark) and desmin (D33, prediluted, Dako). They were negative for CD10 (56C6, prediluted, Dako). CDL with an intravascular growth pattern was diagnosed.