Parasitic leiomyoma presenting as an inguinal hernia in a postmenopausal woman

Abstract

Uterine leiomyomas are one of the most common tumors affecting reproductive-age women. Leiomyomas can present as an intrauterine mass or rarely as an extrauterine tumor. Depending on its location, the diagnosis of extrauterine leiomyoma can be challenging, and multiple imaging modalities may be needed for correct identification and differentiation from malignant entities. We report the case of a 48-year-old-postmenopausal female who presented with a painful left inguinal mass, which was clinically diagnosed as inguinal hernia. Ultrasound, computed tomography, magnetic resonance imaging, and percutaneous biopsy were used to characterize the mass. Surgical resection and histopathological analysis revealed the mass to be a parasitic leiomyoma, a very rare cause of inguinal hernia, especially in a postmenopausal woman.

Keywords: Inguinal hernia; Intra-abdominal mass; Parasitic leiomyoma.

Fig. 1

Ultrasound of the left lower quadrant of the abdomen. (a) and (b) are sagittal and transaxial US images showing the heterogenous hypoechoic left inguinal mass (asterisk). (c) shows that the mass (asterisk) is superficial to common femoral vessels (red and blue in the color Doppler box). (d) is from the US-guided fine needle aspiration showing the needle (white arrow) inside the mass. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article)

Fig. 2

CT of the abdomen and pelvis, with intravenous and oral contrast, and in a portal-venous phase. (a) and (b) are transaxial images at the level of the pelvis (in soft tissue windows), and show an oval well-defined, uniform, soft tissue density, enhancing mass (white arrow). (c) is an oblique maximum intensity projection image showing the extension of the mass into the left inguinal canal (white arrow). (d) is an oblique maximum intensity projection image showing a round ligament vessel supplying the mass (white arrow)

Fig. 3

MRI of the pelvis. (a) and (b) are fat-saturated T1-weighted axial images without and with intravenous contrast, respectively, showing the intermediate to low signal, heterogeneously enhancing mass in the left side of pelvis (white arrow). (c) is a transaxial T1-weighted out-of-phase image showing no evidence of signal drop (white arrow) in relation to the in-phase image (not shown), to suggest microscopic fat. The fat-saturated T2-weighted coronal image (d) shows an intermediate to low signal in the mass with foci of high signal (white arrow) suggesting degeneration in a fibroid

Fig. 4

Hematoxylin and eosin stain (40×) from the resected inguinal mass showing bundles of smooth muscle cells in a fascicular pattern, separated by connected tissue. Occasional fibrillar cytoplasm and hyaline change is also seen