Highly Cellular Leiomyoma Mixed With a Focus of Adenomyosis

Abstract

The purpose of this case presentation was to highlight the importance of an adequate evaluation of images when suspicious of atypical leiomyoma and the importance of performing an extemporaneous biopsy during surgery to ensure the lesion is a benign muscular cell tumor. Here, we present a case of a 34-year-old nulliparous woman who presented with a history of infertility and irregular menstrual cycles. A highly vascularized pelvic mass was visualized by Doppler ultrasound and a contrast MRI suggestive of uterine fibroid. Intraoperatively, the lesion was found adjacent to the uterus, with a second lesion deeper into the myometrium. The pathology reported a highly cellular leiomyoma with a focus of adenomyosis. Both lesions were extirpated without complications. The patient recuperated favorably within three months of follow-up. This case shows an example of a variety of the typical histology that can be found in uterine fibroids. Although the management of atypical leiomyomas could vary in different scenarios, conservative treatment is recommended if fertility wishes are present. In all cases, it is mandatory to exclude any possibilities of malignancy, like sarcoma, which would completely change the intraoperative management.

Keywords: adenomyosis; fibroids; high cellularity; leiomyoma; leiomyosarcoma.

Figure 1. Ultrasound, macroscopic, and histological images of atypical leiomyoma.

(A) Pelvic ultrasonography documented a homogeneous mass lesion right para uterine. (B) Previous image with doppler visualization. (C) Macroscopic lesion with irregular borders and thickness of the myometrium suggestive of leiomyoma. (D) Microscopic image of high cellular tumor leiomyoma composed of sheets of cells increased in number per unit area arranged in clusters of hyperchromatic nuclei with coarse chromatin.