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CLINICAL IMAGE
Year : 2019  |  Volume : 8  |  Issue : 1  |  Page : 44-45

A benign uterine leiomyoma with disturbing appearance


1 Center of Reproductive Medicine, Hangzhou Women's Hospital, Hangzhou, China
2 Department of Pathology, Hangzhou Women's Hospital, Hangzhou, China

Date of Submission12-Aug-2018
Date of Decision19-Oct-2018
Date of Acceptance23-Oct-2018
Date of Web Publication23-Jan-2019

Correspondence Address:
Dr. Xiaoyang Fei
Center of Reproductive Medicine, Hangzhou Women's Hospital, No. 369 Kunpeng Road, Hangzhou 310008
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GMIT.GMIT_78_18

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  Abstract 


Herein, we described a 53-year-old woman who underwent laparoscopic uterine myomectomy. The cut surface of the leiomyoma showed a grain appearance, instead of a whorled feature. The disturbing appearance was an unexpected surprise to the surgeon. The diagnosis of benign uterine leiomyoma was established through intraoperative frozen section and was identical to the subsequent permanent pathology.

Keywords: Grain appearance, laparoscopy, myomectomy, uterine leiomyoma


How to cite this article:
Chen L, Sun W, Chen H, Fei X. A benign uterine leiomyoma with disturbing appearance. Gynecol Minim Invasive Ther 2019;8:44-5

How to cite this URL:
Chen L, Sun W, Chen H, Fei X. A benign uterine leiomyoma with disturbing appearance. Gynecol Minim Invasive Ther [serial online] 2019 [cited 2019 Apr 21];8:44-5. Available from: http://www.e-gmit.com/text.asp?2019/8/1/44/250647



A 53-year-old Chinese woman was referred to our department for the evaluation of a uterine leiomyoma. At presentation, ultrasound showed a well-defined solid mass, 7.0 cm in diameter, connected to the uterine fundus. The patient expressed her appreciation of uterine-sparing surgery in treatment of her leiomyoma. Laparoscopic myomectomy was performed. During laparoscopic surgery, however, the cut surface of the leiomyoma showed a grain appearance [Figure 1], instead of a whorled feature. The subserosal leiomyoma was completely removed. A diagnosis of benign uterine leiomyoma was established through intraoperative frozen section and was identical to the subsequent permanent pathology. Permanent pathology of the leiomyoma showed interlacing bundles of elongated smooth muscle fibers with blunt-ended nuclei that have inconspicuous nucleoli. Postoperative period was uneventful.
Figure 1: Cut surface of the leiomyoma showing a grain appearance

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The gross appearance of uterine leiomyoma is varied.[1] Clinicians need to identify these secondary changes, including some grossly alarming variant of benign uterine leiomyoma.[2] The disturbing appearance presented herein may help gynecologists avoid mistaking it as malignant. Laparoscopic myomectomy can be safely applied to women wishing for a uterine-sparing procedure, providing that patients are carefully selected.[3] Uterine leiomyomas with grain appearance could receive homologous treatment to those with normal whorled feature during laparoscopic uterine myomectomy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Baker P, Oliva E. A practical approach to intraoperative consultation in gynecological pathology. Int J Gynecol Pathol 2008;27:353-65.  Back to cited text no. 1
    
2.
Cheuk W, Chan JK, Liu JY. Cotyledonoid leiomyoma: A benign uterine tumor with alarming gross appearance. Arch Pathol Lab Med 2002;126:210-3.  Back to cited text no. 2
    
3.
Glaser LM, Friedman J, Tsai S, Chaudhari A, Milad M. Laparoscopic myomectomy and morcellation: A review of techniques, outcomes, and practice guidelines. Best Pract Res Clin Obstet Gynaecol 2018;46:99-112.  Back to cited text no. 3
    


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