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. 2016 Jan-Mar;7(1):22-7.
doi: 10.4103/0976-7800.179170.

Uterine Leiomyomas: An ENIGMA

Kempula Geethamala  1 , Venkataramappa Srinivasa Murthy  2 , Bangalore Ramalingiah Vani  2 , Sudha Rao  2
Affiliations

Uterine Leiomyomas: An ENIGMA

Kempula Geethamala et al. J Midlife Health. 2016 Jan-Mar.

Abstract

Introduction: Leiomyomas are benign tumors composed of smooth muscle cells and varying amounts of fibrous connective tissue commonly encountered in women of reproductive age group. Leiomyomas need hormonal milieu for their growth and maintenance. Unopposed estrogenic stimulation manifests as leiomyomas undergoing secondary changes, endometrial proliferation or hyperplasia, and other associated pathological findings.

Objective: To study and analyze various histopathological changes within uterine leiomyomas in hysterectomy specimens. And also, to analyze the associated endometrial and adnexal structures pathology.

Materials and methods: A 4 years retrospective study from June 2010 to June 2014 conducted in the Department of Pathology and Obstetrics and Gynecology, ESIC Medical College and PGIMSR, wherein 820 hysterectomy specimens clinically diagnosed as uterine leiomyomas were subjected to histopathological examination and relevant clinical data were analyzed.

Results: Leiomyomas occurred mostly in women aged 31-50 years (90.23%). Menorrhagia (49.36%) and pain abdomen (30.6%) were the chief clinical manifestations. Endometrial patterns commonly seen were proliferative and hyperplastic endometrium together accounting for 73.4% and dual pathology with adenomyosis was 29.1%. Four cases of tubercular etiology and a single case of granulosa cell tumor of ovary was noted.

Conclusion: Though hysterectomy is a routine procedure in the management of uterine leiomyomas, occasional cases of tumor or infective pathology may be missed. Therefore, histopathology is mandatory and conscientious quest must be done for confirmed diagnosis and ensuring optimal management.

Keywords: Endometrial changes; hysterectomy; leiomyomas.

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Figures

Figure 1
Figure 1
Gross morphology of hysterectomy specimen showing external bosselated surface and cut surface revealing leiomyoma with secondary change. (b) Cut surface showing cervical leiomyoma. (c) Cut surface showing uterine leiomyoma with cystic change and endometrial polyp. (d) Cut surface showing uterine leiomyoma with secondary change and lipomatous area
Figure 2
Figure 2
(a) H and E histopathology section showing leiomyoma with hyalinization. (b) Calcification (c) Cystic change (d) Red degeneration
Figure 3
Figure 3
(a) H and E histopathology section showing leiomyoma with lipomatous change (b) Cellular leiomyoma (c) Smooth muscle tumor of uncertain malignant potential (d) Leiomyosarcoma
Figure 4
Figure 4
(a) H and E histopathology section showing chocolate cyst ovary (b) Tubercular endometritis (c) Tubercular salpingitis (d) Granulosa cell tumor of ovary
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