Leiomioma simplástico del espacio de Retzius en una mujer joven

Se presenta el caso clínico de una fémina de 39 años de edad, quien fue asistida en el Hospital General Docente Guillermo Domínguez López de Puerto Padre, provincia de Las Tunas, por presentar una masa tumoral de aproximadamente 10 cm en el hipogastrio. Luego de realizados el examen clínico y los estudios complementarios pertinentes, se decidió practicar la resección completa del tumor. Durante el procedimiento quirúrgico, se tomó muestra para biopsia cuyo resultado indicó la existencia de un leiomioma simplástico en el espacio de Retzius. La paciente evolucionó satisfactoriamente y egresó de la institución a los 5 días, pero se continuó su seguimiento por consulta externa.

The case report of a 39 years woman is presented, who was assisted in Guillermo Domínguez López Teaching General Hospital from Puerto Padre, Las Tunas province, due to a tumoral mass of around 10 cm in the hypogastrium. After the clinical exam and the pertinent complementary studies, it was decided to practice the complete resection of the tumor. During the surgical procedure, a sample for biopsy was taken which result indicated the existence of a symplastic leiomyoma in the Retzius space. The patient had a favorable clinical course and she was discharged from the institution 5 days later, but continued with follow up in outpatient department.

A rare case of symplastic leiomyoma: case report

Symplastic leiomyoma is an unusual variant of leiomyoma. Malignant transformation accounts for 0.2% of all cases of leiomyoma. Atypical and bizarre leiomyoma synonymous with symplastic leiomyoma are rare smooth muscle tumors that contain cells with moderate to severe cytological atypia, still cell necrosis is absent and mitotic index is fewer than 10/10 HPF. A 42-year P1L1A3 with no comorbidities came with complaints of lower abdominal pain for one year and heavy menstrual bleeding for eight months, LMP- 15/2/19, regular cycles, changes 4-5 pads/day, clots (+) (+), dysmenorrhoea (+). Parity score of P1L1A3, LCB-24 years, not sterilized. On examination - moderately built and nourished, pallor (+). Per abdomen examination - uterus - 22 weeks size, irregular mass, arising from pelvis - no tenderness, lower border not made out. Per speculum examination - cervix and vagina healthy. Per vagina examination - cervix firm, posterior, left fornix: mass felt, non-tender. The patient underwent Abdominal hysterectomy and B/L salpingo-oophorectomy under CSEA. Intraoperative findings - uterus - 20 weeks size, enlarged, a posterior wall subserosal fibroid with degeneration of 6×8 cm. Microscopic appearance - uterus - myometrium shows changes in adenomyosis. Sections of smaller mass reveal structure of leiomyoma. Nuclei are large, hyperchromatic, and show coarse chromatin clumps. Many giant-sized cells with multiple large nuclei were seen. It showed large chromatin clumps. Stroma showed myxoid change. Diagnosis - symplastic leiomyoma, adenomyosis. Symplastic leiomyoma is an unusual variant of leiomyoma. Malignant transformation accounts for 0.2% of all cases of leiomyoma. The regularity of the tumor margins, low mitotic activity, and absence of nuclear atypia or necrosis should be made for the exclusion of malignancy.

Endometrioid carcinoma infiltrating atypical leiomyoma: A mimicker of malignant mixed Mullerian tumor.

Atypical or symplastic leiomyoma is a rare histological variant of leiomyoma. This is a case report of 63-year-old patient who underwent hysterectomy with bilateral salpingo-oophorectomy. Histopathology of the polypoid growth seen in the endometrial cavity revealed atypical leiomyoma infi ltrated by endometrioid cancer. Atypical leiomyoma can be misdiagnosed as leiomyosarcoma. Thus, carcinosarcoma was ruled out as it has an ominous prognosis. A diagnosis of atypical leiomyoma infi ltrated by endometrioid cancer was given. We report this case as there are very few case reports of the above two pathology occurring simultaneously in the same patient.

Leiomioma atípico / Atypical leiomyoma

Os autores relatam o caso de um leiomioma atípico ocasionalmente identificado em uma mulher de 45 anos submetida a histerectomia por sangramento uterino anormal. O leiomioma atípico, também conhecido como leiomioma bizarro ou simplástico, é um tumor pouco comum, sendo responsável por 0,5% a 1,0% das neoplasias mesenquimais uterinas. É caracterizado pela presença de células gigantes com múltiplos núcleos pleomórficos e cromatina grumosa. O seu comportamento biológico depende do seu índex mitótico e da presença de necrose tumoral. Paralelamente ao relato do caso, são discutidos os achados histopatológicos e clínicos do leiomioma atípico e a importância do seu diagnóstico diferencial com neoplasias malignas uterinas como o leiomiossarcoma.

The authors report a case of atypical leiomyoma occasionally identified in a woman of 45 who underwent hysterectomy for abnormal uterine bleeding. Atypical leiomyoma, also known as symplastic or bizarre leiomyoma, is an uncommon tumor accounting for 0.5-1.0% of uterine mesenchymal neoplasms. It is characterized by the presence of giant cells with multiple pleomorphic nuclei and granular chromatin. Its biological behavior depends on their mitotic index and the presence of tumor necrosis. Parallel to the case report we discuss the clinical and histopathological findings of atypical leiomyoma and the importance of its differential diagnosis with malignant uterine neoplasms such as leiomyosarcoma.