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Table of Contents
CLINICAL IMAGE
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 182-183

Primary ovarian leiomyoma


Department of Gynaec Endoscopy, Women' Hospital, Mumbai, Maharashtra, India

Date of Submission20-May-2019
Date of Decision12-Nov-2019
Date of Acceptance08-Jan-2020
Date of Web Publication1-Aug-2020

Correspondence Address:
Dr. Sharda Arvind
Department of Gynaec Endoscopy, Women's Hospital, 674, 16th Cross Road, Behind Khar Gymkhana, Khar West, Mumbai - 400 052, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GMIT.GMIT_14_19

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  Abstract 


Primary ovarian leiomyoma is an extremely rare form of extrauterine leiomyomas. The incidence of primary ovarian leiomyoma is 0.5%–1% of all benign ovarian smooth muscle tumors. We present a case of primary ovarian leiomyoma managed laparoscopically with ovarian preservation.

Keywords: Extrauterine leiomyoma, immunohistochemistry, laparoscopy, ovarian leiomyoma, rare leiomyoma


How to cite this article:
Raje S, Arvind S, Rao G, Chawla L. Primary ovarian leiomyoma. Gynecol Minim Invasive Ther 2020;9:182-3

How to cite this URL:
Raje S, Arvind S, Rao G, Chawla L. Primary ovarian leiomyoma. Gynecol Minim Invasive Ther [serial online] 2020 [cited 2020 Aug 12];9:182-3. Available from: http://www.e-gmit.com/text.asp?2020/9/3/182/291259



We present a rare case of primary ovarian leiomyoma managed laparoscopically with ovarian preservation. A 31-year-old, P1 L1, female with regular menses had an incidental finding of right adnexal mass on ultrasound. Pelvic magnetic resonance imaging was suggestive of 5 cm × 4 cm × 4 cm, well-circumscribed, right ovarian solid mass with low-intensity signals on both T1 and T2 images [Figure 1]. Tumor markers were negative for ovarian malignancy. Intraoperative frozen section can be used to determine the nature of tumor. Intraoperatively, a solid right ovarian mass was seen. The ovarian surface was smooth. There were no adhesions to the surrounding structures. Uterus, left ovary, and both  Fallopian tube More Detailss were unremarkable [Figure 2]. After making an incision on the ovarian capsule, sharp dissection was performed to carefully dissect the fibroid from the normal ovarian tissue. Laparoscopic excision of the right ovarian mass with contained tissue extraction and ovarian preservation was done [Figure 3]. Patient recovery was uneventful. Follow-up after 1 year did not show any recurrence. Histological examination showed strands of smooth muscle cells with ovoid nuclei arranged in whorled pattern. Immunohistochemistry showed positive staining for smooth muscle actin, confirming the diagnosis of ovarian leiomyoma [Figure 4].
Figure 1: Magnetic resonance imaging: Right ovarian mass

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Figure 2: Laparoscopy: Right ovarian solid mass

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Figure 3: Laparoscopic excision of the right ovarian mass with ovarian preservation

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Figure 4: (a) Strands of smooth muscle cells with ovoid nuclei arranged in whorled pattern (H and E, ×40). (b) Smooth muscle actin immunostain: The tumor cells express smooth muscle actin

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Primary ovarian leiomyoma is an extremely rare form of extrauterine leiomyomas. The incidence of primary ovarian leiomyoma is 0.5%–1% of all benign ovarian smooth muscle tumors.[1],[2] It may originate from smooth muscles of hilar vessels, undifferentiated germ cells in ovarian stroma, ovarian ligament, stroma of endometriosis, and remnant of Wolffian body.[1],[2] Most of these tumors are unilateral, small in size, and occur in premenopausal women. The differential diagnoses for primary ovarian leiomyoma include broad-ligament fibroid, subserous adenexal pedunculated fibroid, solid ovarian stromal tumor, secondary involvement of ovarian hilar vessels in case of intravenous leiomyomatosis, and leiomyomatosis peritonealis disseminate. It may be difficult to distinguish between ovarian fibroma and leiomyoma intraoperatively. Histopathology and immunochemical analysis confirm the diagnosis. Although ovarian leiomyomas are benign, the usual approach has been oophorectomy considering the solid nature of tumor. Laparoscopic management with ovarian preservation can be considered with appropriate preoperative evaluation to rule out ovarian malignancy.

Ethical Statement

The study was approved by the institutional ethics committee of Women's Hospital, Mumbai (IRB approval number 1066/2018 obtained on March 5th, 2019).

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 initials 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.
Kim M. Laparoscopic management of a twisted ovarian leiomyoma in a woman with 10 weeks' gestation: Case report and literature review. Medicine (Baltimore) 2016;95:e5319.  Back to cited text no. 1
    
2.
Taskin MI, Ozturk E, Yildirim F, Ozdemir N, Inceboz U. Primary ovarian leiomyoma: A case report. Int J Surg Case Rep 2014;5:665-8.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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