An unusual case report: retroperitoneal hydropic leiomyoma

Abstract

Leiomyomas are one of the most prevalent gynecological conditions that cause bleeding in women, particularly in the postmenopausal and perimenopausal stages. Nonetheless, one of the rarest forms of myoma is retroperitoneal hydropic myoma. A 45-year-old woman with a history of four pregnancies, two cesarean sections, one vaginal delivery, and one abortion will be the subject of this case presentation. During her preoperative examination, a retroperitoneal hydropic myoma was discovered to be an adnexal mass. The patient's preoperative pelvic MRI was interpreted as follows: Approximately 15 x 16 cm in size, a giant cystic mass lesion filled the pelvis completely and extended superiorly to the umbilical level. It contained contrast-enhancing septal components, and in the superior left half, there was a contrast-enhancing and diffusion-restricting solid component that measured about 4 x 3 cm and was believed to be from the right ovary (mucinous ovarian carcinoma?). The uterus is being forced anteriorly by the giant mass lesion that has been described. A retroperitoneal cystic tumor was removed during the procedure. A hydropic leiomyoma without necrosis or hemorrhage was discovered by microscopic and histopathologic analysis. The hydropic degeneration of the leiomyoma and its uncommon location make this case remarkable. Furthermore, it was difficult to make an accurate diagnosis because it initially resembled an ovarian cyst.

Keywords

• Ovarian cyst
• leiomyoma
• retroperitoneal leoimyoma
• hydropic leiomyoma
• retroperitoneal hydropic leiomyoma

Sıra dışı bir olgu sunumu: retroperitoneal hidropik leiomyom

Abstract

Leiomyomlar, özellikle postmenopozal ve perimenopozal dönemlerde kadınlarda kanamaya neden olan en yaygın jinekolojik rahatsızlıklardan biridir. Bununla birlikte, en nadir miyom türlerinden biri retroperitoneal hidropik miyomdur. Dört gebelik, iki sezaryen, bir vajinal doğum ve bir kürtaj öyküsü olan 45 yaşında bir kadın bu olgu sunumunun konusu olacaktır. Ameliyat öncesi muayenesinde, retroperitoneal hidropik miyomun adneksiyel bir kitle olduğu tespit edildi. Hastanın ameliyat öncesi pelvik MR'ı şu şekilde yorumlandı: Yaklaşık 15 x 16 cm boyutlarında, pelvisi tamamen dolduran ve göbek hizasına kadar uzanan dev bir kistik kitle lezyonu. Kontrast madde içeren septal komponentler ve üst sol yarısında, yaklaşık 4 x 3 cm boyutlarında, sağ overden kaynaklandığı düşünülen kontrast madde içeren ve difüzyonu kısıtlayan solid bir komponent (müsinöz over karsinomu?) mevcuttu. Uterus, tarif edilen dev kitle lezyonu tarafından öne doğru itilmekteydi. İşlem sırasında retroperitoneal kistik bir tümör çıkarıldı. Mikroskobik ve histopatolojik analizler sonucunda nekroz veya kanama olmaksızın hidropik leiomyom tanısı konuldu. Leiomyomun hidropik dejenerasyonu ve nadir görülen yerleşimi bu olguyu dikkat çekici kılmaktadır. Ayrıca, başlangıçta bir over kistine benzediği için doğru tanı koymak zordu.

Keywords

• Over kisti
• leiomyom
• retroperitoneal leiomyom
• hidropik leiomyom
• retroperitoneal hidropik leiomyom

References

1. Murata T, Kyozuka H, Endo Y, et al. Preterm Deliveries in Women with Uterine Myomas: The Japan Environment and Children's Study. Int J Environ Res Public Health. 2021;18(5):2246. doi:10.3390/ijerph18052246
2. Wilde S, Scott-Barrett S. Radiological appearances of uterine fibroids. Indian J Radiol Imaging. 2009;19(3):222-231. doi:10.4103/0971-3026.54887
3. Poliquin V, Victory R, Vilos GA. Epidemiology, presentation, and management of retroperitoneal leiomyomata: systematic literature review and case report. J Minim Invasive Gynecol. 2008;15(2):152-160. doi:10.1016/j.jmig.2007.12.009
4. Griffin BB, Ban Y, Lu X, Wei JJ. Hydropic leiomyoma: a distinct variant of leiomyoma closely related to HMGA2 overexpression. Hum Pathol. 2019;84:164-172. doi:10.1016/j.humpath.2018.09.012
5. Popovici RM, Cărăuleanu A, Costea CF, et al. Rare retroperitoneal conditions that mimic uterine myoma. Rom J Morphol Embryol. 2020;61(1):7-14. doi:10.47162/RJME.61.1.01
6. Karray O, Boulma R, Abdi A, et al. Management of a giant retroperitoneal leiomyoma: a case report. J Med Case Rep. 2018;12(1):81. doi:10.1186/s13256-018-1617-z
7. Woźniak A, Woźniak S. Ultrasonography of uterine leiomyomas. Prz Menopauzalny. 2017;16(4):113-117. doi:10.5114/pm.2017.72754
8. Sabrine D, Hafsa E, Omar M, et al. Retroperitoneal leiomyoma of gynecologic type: a case report and review of the litterature. J Surg Case Rep. 2020;2020(12):rjaa489. doi:10.1093/jscr/rjaa489

9. Babacan A, Kizilaslan C, Gun I, Muhcu M, Mungen E, Atay V. CA 125 and other tumor markers in uterine leiomyomas and their association with lesion characteristics. Int J Clin Exp Med. 2014;7(4):1078-1083.
10. Yamaguchi T, Kyozuka H, Kochi Y, et al. Hydropic leiomyoma-like ovarian tumor: a case report. Fukushima J Med Sci. 2024;70(2):93-98. doi:10.5387/fms.2023-22
11. Gök S, Alataş E, Düzcan E. Overin nadir tümörü: sklerozan stromal tümör. Pam Tıp Derg. 2020;13(2):449-452. doi:10.31362/patd.670426
12. Billings SD, Folpe AL, Weiss SW. Do leiomyomas of deep soft tissue exist? An analysis of highly differentiated smooth muscle tumors of deep soft tissue supporting two distinct subtypes. Am J Surg Pathol. 2001;25(9):1134-1142. doi:10.1097/00000478-200109000-00003
13. Strauss DC, Hayes AJ, Thomas JM. Retroperitoneal tumours: review of management. Ann R Coll Surg Engl. 2011;93(4):275-280. doi:10.1308/003588411X571944
14. Lee F, Huang TS, Ng XY, Ko WC, Liu CL, Lin JC. Surgical management of primary retroperitoneal tumors – Analysis of a single center experience. Journal of Cancer Research and Practice. 2017;4(2):49-52. doi:10.1016/j.jcrpr.2017.01.001
15. Miettinen M. Smooth muscle tumors of soft tissue and non-uterine viscera: biology and prognosis. Mod Pathol. 2014;27(Suppl 1):S17-S29. doi:10.1038/modpathol.2013.178