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A subserosal, pedunculated, multilocular uterine leiomyoma with ovarian tumor-like morphology and histological architecture of adenomatoid tumors: a case report and review of the literature.
J Med Case Rep. 2016 Dec 20; 10(1):352.JM

Abstract

BACKGROUND

Uterine leiomyomas are common uterine tumors, and typical cases of leiomyoma are easily diagnosed by imaging study. However, uterine leiomyomas are often altered by degenerative changes, which can cause difficulty and confusion in their clinical diagnosis. We describe the 17th reported case of a uterine leiomyoma clinically diagnosed as an ovarian tumor; however, the present case shows the most detailed radiological evaluation, including contrast-enhanced magnetic resonance imaging. We first show that a uterine leiomyoma can histologically mimic an adenomatoid tumor.

CASE PRESENTATION

A 47-year-old premenopausal, nulliparous Japanese woman with a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia had lower abdominal pain. Ultrasonography confirmed a 6-cm mass in the right-sided space of the pelvic cavity. Magnetic resonance imaging evaluation showed that a multilocular mass was present near the uterus, and a mucinous ovarian tumor was considered. Emergency surgery due to acute abdomen was performed under the diagnosis of pedicle torsion of the ovarian tumor. During surgery, a pedunculated uterine mass without stalk torsion was seen. The mass grossly contained serous and hemorrhagic fluids in the cavities, and pathology examination confirmed that the mass was a leiomyoma with hydropic and cystic degeneration. Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. The tumor cells were positive for the microphthalmia transcription factor but negative for other melanoma markers. Three days postoperatively, she was discharged without sequelae.

CONCLUSIONS

Marked intratumoral deposition of fluids may induce the multilocular morphology of a tumor, and the cellular arrangement of the tumor cells with hydropic degeneration mimicked an adenomatoid tumor in this case. Clinicians need to be aware that a subserosal leiomyoma with cystic and hydropic degeneration can mimic an ovarian tumor, and pathologists should be aware that such leiomyomas can mimic adenomatoid tumors. Additionally, perivascular epithelioid cell tumors should not be diagnosed only based on its immunoreactivity for the microphthalmia transcription factor.

Authors+Show Affiliations

Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan. kenjiyorita@gmail.com.Department of Obstetrics and Gynecology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan.Department of Obstetrics and Gynecology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan.Department of Obstetrics and Gynecology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan.Department of Internal Medicine, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan.Department of Radiology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan.Department of Radiology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan.Minaminokaze Clinic, 3-7-1, Sakaemachi, Kochi-city, Kochi, 780-0061, Japan.Department of Pathology, Shinyurigaoka, General Hospital, 255, Furusawa, Asao-ku, Kawasaki-city, Kanagawa, 215-0026, Japan.Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

27998309

Citation

Yorita, Kenji, et al. "A Subserosal, Pedunculated, Multilocular Uterine Leiomyoma With Ovarian Tumor-like Morphology and Histological Architecture of Adenomatoid Tumors: a Case Report and Review of the Literature." Journal of Medical Case Reports, vol. 10, no. 1, 2016, p. 352.
Yorita K, Tanaka Y, Hirano K, et al. A subserosal, pedunculated, multilocular uterine leiomyoma with ovarian tumor-like morphology and histological architecture of adenomatoid tumors: a case report and review of the literature. J Med Case Rep. 2016;10(1):352.
Yorita, K., Tanaka, Y., Hirano, K., Kai, Y., Arii, K., Nakatani, K., Ito, S., Imai, T., Fukunaga, M., & Kuroda, N. (2016). A subserosal, pedunculated, multilocular uterine leiomyoma with ovarian tumor-like morphology and histological architecture of adenomatoid tumors: a case report and review of the literature. Journal of Medical Case Reports, 10(1), 352. https://doi.org/10.1186/s13256-016-1167-1
Yorita K, et al. A Subserosal, Pedunculated, Multilocular Uterine Leiomyoma With Ovarian Tumor-like Morphology and Histological Architecture of Adenomatoid Tumors: a Case Report and Review of the Literature. J Med Case Rep. 2016 Dec 20;10(1):352. PubMed PMID: 27998309.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A subserosal, pedunculated, multilocular uterine leiomyoma with ovarian tumor-like morphology and histological architecture of adenomatoid tumors: a case report and review of the literature. AU - Yorita,Kenji, AU - Tanaka,Yu, AU - Hirano,Koki, AU - Kai,Yuka, AU - Arii,Kaoru, AU - Nakatani,Kimiko, AU - Ito,Satoshi, AU - Imai,Toshiya, AU - Fukunaga,Masaharu, AU - Kuroda,Naoto, Y1 - 2016/12/20/ PY - 2016/08/10/received PY - 2016/12/01/accepted PY - 2016/12/22/entrez PY - 2016/12/22/pubmed PY - 2017/5/13/medline KW - Adenomatoid tumor KW - Cystic degeneration KW - Hydropic degeneration KW - Leiomyoma SP - 352 EP - 352 JF - Journal of medical case reports JO - J Med Case Rep VL - 10 IS - 1 N2 - BACKGROUND: Uterine leiomyomas are common uterine tumors, and typical cases of leiomyoma are easily diagnosed by imaging study. However, uterine leiomyomas are often altered by degenerative changes, which can cause difficulty and confusion in their clinical diagnosis. We describe the 17th reported case of a uterine leiomyoma clinically diagnosed as an ovarian tumor; however, the present case shows the most detailed radiological evaluation, including contrast-enhanced magnetic resonance imaging. We first show that a uterine leiomyoma can histologically mimic an adenomatoid tumor. CASE PRESENTATION: A 47-year-old premenopausal, nulliparous Japanese woman with a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia had lower abdominal pain. Ultrasonography confirmed a 6-cm mass in the right-sided space of the pelvic cavity. Magnetic resonance imaging evaluation showed that a multilocular mass was present near the uterus, and a mucinous ovarian tumor was considered. Emergency surgery due to acute abdomen was performed under the diagnosis of pedicle torsion of the ovarian tumor. During surgery, a pedunculated uterine mass without stalk torsion was seen. The mass grossly contained serous and hemorrhagic fluids in the cavities, and pathology examination confirmed that the mass was a leiomyoma with hydropic and cystic degeneration. Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. The tumor cells were positive for the microphthalmia transcription factor but negative for other melanoma markers. Three days postoperatively, she was discharged without sequelae. CONCLUSIONS: Marked intratumoral deposition of fluids may induce the multilocular morphology of a tumor, and the cellular arrangement of the tumor cells with hydropic degeneration mimicked an adenomatoid tumor in this case. Clinicians need to be aware that a subserosal leiomyoma with cystic and hydropic degeneration can mimic an ovarian tumor, and pathologists should be aware that such leiomyomas can mimic adenomatoid tumors. Additionally, perivascular epithelioid cell tumors should not be diagnosed only based on its immunoreactivity for the microphthalmia transcription factor. SN - 1752-1947 UR - https://www.unboundmedicine.com/medline/citation/27998309/A_subserosal_pedunculated_multilocular_uterine_leiomyoma_with_ovarian_tumor_like_morphology_and_histological_architecture_of_adenomatoid_tumors:_a_case_report_and_review_of_the_literature_ L2 - https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-016-1167-1 DB - PRIME DP - Unbound Medicine ER -