Diagnostic Dilemma: Large Primary Ovarian Leiomyoma Imitating Fibroma in a Postmenopausal Patient: Case Report.

Ruchi Sinha; Preetika Sinha; Tarun Kumar; Avinash Singh; Shankhanila Mazumdar

doi:10.51168/tzq30840

Authors

Dr. Ruchi Sinha Professor, Department of Pathology & Laboratory Medicine, College of All India Institute of Medical Sciences, Patna Author
Dr. Preetika Sinha Senior Resident , Pathology & Laboratory Medicine College, India Institute of Medical Sciences, Patna Author
Dr. Tarun Kumar Associate Professor, Department of Pathology & Laboratory Medicine, College of All India Institute of Medical Sciences, Patna Author
Dr. Avinash Singh Associate Professor, Department of Pathology & Laboratory Medicine, College of All India Institute of Medical Sciences, Patna Author
Dr. Shankhanila Mazumdar Senior Resident, Department of Pathology & Laboratory Medicine, College of All India Institute of Medical Sciences, Patna Author

DOI:

https://doi.org/10.51168/tzq30840

Keywords:

Ovarian leiomyoma, postmenopausal, primary, immunohistochemistry

Abstract

Primary ovarian leiomyoma is extremely uncommon, with a low incidence rate of 0.5-1% of benign ovarian tumors. Due to its rarity, it poses a diagnostic dilemma and needs to be differentiated from other spindle cell neoplasms of the ovary. We report a case of a large symptomatic primary ovarian leiomyoma in a postmenopausal woman, which was misdiagnosed as fibroma of the ovary both clinically and radiologically. Microscopy revealed a spindle cell tumor arranged in short intersecting fascicles, which were positive for SMA and h-caldesmon on immunohistochemistry. is a useful adjunct for definitive diagnosis and confirming smooth muscle origin. While malignant solid ovarian tumors are much more common, the consideration of ovarian leiomyoma as a differential diagnosis of solid ovarian tumors is essential, as the treatment modality is surgical resection. Diagnosing ovarian leiomyoma before and during surgery is challenging. It is advisable to perform both histopathological examination and immunohistochemical analysis.

Author Biography

Dr. Preetika Sinha, Senior Resident , Pathology & Laboratory Medicine College, India Institute of Medical Sciences, Patna

S

References

1. Moch H, editor. Female genital tumours: WHO classification of tumours. 5th ed. Vol. 4. Lyon (FR): International Agency for Research on Cancer; 2020.

2. Agarwal R, Kumar M, Agarwal L, Agarwal KK. A huge primary ovarian leiomyoma with degenerative changes: An unusual presentation. J Clin Diagn Res. 2013;7:1152-4. https://doi.org/10.7860/JCDR/2013/5313.3060

3. Kurai M, Shiozawa T, Noguchi H, Konishi I. Leiomyoma of the ovary presenting with Meigs' syndrome. J Obstet Gynaecol Res. 2005;31:257-62. https://doi.org/10.1111/j.1447-0756.2005.00285.x

4. Blue NR, Felix JC, Jaque J. Primary ovarian leiomyoma in a premenarchal adolescent: First reported case. J Pediatr Adolesc Gynecol. 2014;27:87-8. https://doi.org/10.1016/j.jpag.2013.07.011

5. 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. https://doi.org/10.1016/j.ijscr.2014.07.020

6. Meel M, Hemrajani D, Kumar M, Agnani B. Symptomatic primary ovarian leiomyoma in a postmenopausal woman: A rare entity. J Midlife Health. 2020;11:175-7 https://doi.org/10.4103/jmh.JMH_105_19

7. Rajesh S, Adam M. Benign metastasizing leiomyoma: "A sheep in wolf's clothing." Community Oncol. 2013;10:122-5 https://doi.org/10.12788/j.cmonc.0006

8. Lerwill MF, Sung R, Oliva E, Prat J, Young RH. Smooth muscle tumors of the ovary: a clinicopathologic study of 54 cases emphasizing prognostic criteria, histologic variants, and differential diagnosis. Am J Surg Pathol. 2004 Nov;28(11):1436-51. doi:10.1097/01.pas.0000141393.99300.d0. PMID: 15489647.https://doi.org/10.1097/01.pas.0000141393.99300.d0

9. Erdemoglu E, Kamaci M, Bayram I, Güler A, Güler Sahin H. Primary giant leiomyoma of the ovary--case report. Eur J Gynaecol Oncol. 2006;27(6):634-5. PMID: 17290603.

10. 10 Pandit MJ, Watson NR, Mackenzie IZ. Leiomyoma of the ovary. J Obstet Gynaecol. 1997;17:503-4

https://doi.org/10.1080/01443619750112664

11. 11 Lim SC, Jeon HJ. Bilateral primary ovarian leiomyoma in a young woman: Case report and literature review. Gynecol Oncol. 2004;95:733-5 https://doi.org/10.1016/j.ygyno.2004.07.048

12. 12 Bharti S, Khera S, Sharma C, Balakrishnan A. Unilateral primary ovarian leiomyoma masqueraded as ovarian fibroma: A histopathological diagnosis. Journal of Family Medicine and Primary Care 10(9):3494-3497, September 2021. https://doi.org/10.4103/jfmpc.jfmpc_2546_20

13. 13 Patne SC, Kumar M, Raghuvanshi S, Agarwal NR. Unilateral primary ovarian leiomyoma with degeneration masquerading as ovarian malignancy. World J Surg Res. 2013;2:50-3

14. 14 Kataria SP, Chawla N, Singh G, Kum S. Ovarian leiomyoma associated with serous cystadenoma - A case report of an uncommon entity. Global J Pathol Microbiol. 2014;14:38-42

15. 15 Yasushi K., Noriyuki T., Masako S., Kaei N., Isao M. Magnetic resonance imaging findings in leiomyoma of the ovary: a case report. Arch Gynecol Obstet. 2005;273:298-300. https://doi.org/10.1007/s00404-005-0085-z

16. 16 Tomas D., Lenicek T., Tuckar N., Puljiz Z., Ledinsky M., Kruslin B. Primary ovarian leiomyoma associated with endometriotic cyst presenting with symptoms of acute appendicitis: a case report. Diagn Pathol. 2009;4:25

https://doi.org/10.1186/1746-1596-4-25

17. 17 Fallahzadeh H, Dockerty MB, Lee RA. Leiomyoma of the ovary: Report of five cases and review of the literature. Am J Obstet Gynecol 1972;113:394‐8. https://doi.org/10.1016/0002-9378(72)90691-6

18. 18 Gunasekaran I, Phansalkar M, Palo LB, Varghese RG. Ovarian Leiomyoma Along with Uterine Leiomyomata: A Common Tumour at an Uncommon Site. J Clin Diagn Res. 2015 Nov;9(11)

https://doi.org/10.7860/JCDR/2015/13378.6703