Gross: However, we cannot answer medical or research questions or give advice. Can cause pressure symptoms due to compression on adjoining structures. Extensive hydropic degeneration in uterine leiomyoma is a rare occurrence and is commonly reported in association with pregnancy. Specifically, a rapidly growing uterine mass is not a reliable predictor of leiomyosarcoma according to Parker et al. The common cause is due to obstruction of venous drainage at the periphery of the lesion. Myxoid degeneration in a huge uterine leiomyoma: an unusual benign pathology mimiking malignancy 117 Fig. Reports of leiomyoma with marked cystic degeneration have been relatively uncommon (Aydin et al., 2013). Am J Surg Pathol. The most common abnormalities are translocations on chromosome 12; deletion on chromosomes 3q and 7q. They can also interfere in fertility. Polarizing Microscopy Simplified! Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. 1. The tumor is diagnosed histologically by a pathologist by observing a tumor … With minimal discussion in the surgical pathology literature, appropriate evaluation may be challenging because the differential diagnosis includes other uncommon uterine disorders such as intravenous leiomyomatosis, diffuse leiomyomatosis, myxoid … Highly cellular variant and lipoleiomyomas will be yellowish in color. Hydropic change is another form of degeneration with a similar MRI appearance, and is due to an accumulation of oedema fluid in the connective tissue of the leiomyoma. A variety of unusual growth patterns can occur in uterine leiomyomas, such as diffuse uterine leiomyomatosis, disseminated peritoneal leiomyomatosis, benign metastasizing leiomyoma, parasitic leiomyoma, intravascular leiomyomatosis, dissecting leiomyoma, and leiomyoma with perinodular hydropic degeneration.1 In 1996, Roth et al2 reported a series of 4 cases of leiomyoma characterized … They can be single or multiple. Hydropic degenerating leiomyomas are characterized by focal accumulation of edema and collagen deposition. There are many microscopic variants which include cellular, Leiomyoma with bizzare nuclei, Mitotically active, hydropic, apopletic, lipomatous, epithelioid, myxoid, dissecting leiomyomas etc. A leiomyoma is a benign smooth muscle tumor that can develop anywhere in the body Hydropic Leiomyoma of Uterine Corpus is an uncommon morphological variant of Uterine Corpus Leiomyoma. Hydropic changes lead to formation of cystic cavities. Posted by Dr Vijay Shankar S | Jan 11, 2021 | Female Genital System & Breast |. Increased awareness of this grossly alarming variant of benign uterine leiomyoma can help avoid overtreatment. Hyalinization is the commonest type of degeneration. Apple Green Birefringence. Cotyledonoid leiomyoma apparently results from a combination of several uncommon growth patterns operating together, including subserosal growth, dissecting growth, and perinodular hydropic degeneration. We describe a case of a 35-year-old woman with a pedunculated uterine leiomyoma with diffuse hydropic degeneration presenting as a giant abdominal mass. These are usually asymptomatic if small and are often incidental finding. The patient was admitted in the emergency department because of diffuse abdominal bloating and discomfort. Ovary tumor - Leiomyoma. Author information: (1)Department of Pathology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur. Loves to promote social media for education in Pathology, Designed by Elegant Themes | Powered by WordPress, ANTICOAGULANTS in Hematologic Investigations, Understanding AZZOPARDI PHENOMENON / EFFECT. Diffuse, perinodular, and other patterns of hydropic degeneration within and adjacent to uterine leiomyomas: problems in differential diagnosis. This is a complication usually occurs in pregnancy. Uncomplicated leiomyomas are of a heterogeneous echo texture and vary from hypoechoic to hyperechoic, sometimes containing calcifications with acoustic shadowing. Address correspondence and reprint requests to Dr. Lawrence M. Roth, Department of Pathology, University Hospital, Room 3465, 550 North University Boulevard, Indianapolis, IN 46202-5280, U.S.A. ... and one was a multinodular leiomyoma with hydropic degeneration. We welcome suggestions or questions about using the website. Leiomyoma dissects into myometrium (black arrow) at the cornu; hydropic change is present around smooth muscle bundles (perinodular hydropic degeneration) Microscopically, the nodules were separated by extensive hydropic degeneration. Intramural: within the myometrium. is present around smooth muscle bundles Cotyledonoid dissecting leiomyoma is an extremely rare variant of uterine leiomyoma with an unusual growth pattern characterized by an extrauterine mass that resembles a placenta and histologically shows an intramural dissecting pattern in the uterus [2, 3]. 2) and distinguished from the interstitial edema commonly seen in leiomyomata. Uterine Leiomyoma: These are the benign tumors of smooth muscle of uterus. Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. Submucosal: present benath the endometrium. Geographic areas of hydropic degeneration were identified (Fig. With minimal discussion in the surgical pathology literature, appropriate evaluation may be challenging because the differential diagnosis includes other uncommon uterine disorders such as intravenous leiomyomatosis, diffuse leiomyomatosis, myxoid … If the tumor is very large, the degenerative changes can be seen. Multinodular hydropic leiomyoma (MHL) of the uterus is one of the rarest variants of uterine leiomyomas and can create some diagnostic problems. arrow) at the cornu; hydropic change 2b). The common cause is due to obstruction of venous drainage at the periphery of the lesion. No reported case of pseudo-Meigs syndrome presenting with hydropic degeneration of uterine leiomyoma and an elevated CA 125 level could be found on a MEDLINE search. 2 The uterus can enlarge and may have a lobulated contour. Hydropic degeneration is characterized by accumulation of oedema fluid with associated collagen deposition presenting with various patterns [5], [6]. Etiology: Exact etiology is not known, however age of menarche and parity are important risk factors. It is a close mimicker of malignancy due to rapid growth and atypical imaging appearances. The mass grossly contained serous and hemorrhagic fluids in the cavities, and pathology examination confirmed that the mass was a leiomyoma with hydropic and cystic degeneration. Based on the location of the tumor they are categorized as Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. Cytogenetic abnormalities: 40 to 50% of uterine leiomyomas show karyotypic abnormalities. Microscopy: the pattern is that of interlacing fascicles or whorling of smooth muscle cells. 1992 ;16: 26 - 32 . reviewed 20 cases of cotyledonoid dissecting leiomyoma . Subserosal they are seen beneath the serosa. Edematous change, referred to as hydropic degeneration, is a common form of degeneration seen focally in up to 50% of patients with leiomyoma . This is a complication usually occurs in pregnancy. Cotyledonoid hydropic intravenous leiomyomatosis: a new variant leiomyoma. Red Degeneration: This is due to hemorrhagic infaction of a leiomyoma. 1. Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. Ultrasonography (US) showed a heterogeneous abdominopelvic mass. 1) was described and distinguished from the interstitial hyaline degeneration that is commonly seen in uterine leiomyomata. Only five cases have been reported previously. This website is intended for pathologists and laboratory personnel but not for patients. These are usually multiple with sizes ranging from microscopic foci to large bulky tumors. Table 1 summarizes ordinary leiomyomas, including their various forms of degeneration, and their main variants. The nodules were composed of cigar-shaped spindle cells with no mitosis, cellular pleomorphism or coagulation necrosis. This is also referred to as Carneous degeneration. These are the ones which can manifest with menorrhagia. But can manifest with abnormal uterine bleeding which is more common in submucosal leiomyomas. The present case was uncommon in that it exhibited umbilical endometriosis, an extremely enlarged uterus due to marked hydropic and cystic degeneration of the leiomyomas, and torsion of the pedicle of the right ovarian cyst that had caused sudden pain in the right lower abdomen. Cystic degeneration is an extreme sequel of edema. Red Degeneration: This is due to hemorrhagic infaction of a leiomyoma. Morphology:
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