Apple Green Birefringence. © Copyright PathologyOutlines.com, Inc. Click, Also called dissecting cotyledonoid leiomyoma, Sternberg tumor (, Rare benign tumor characterized by extrauterine bulbous growth continuous with a dissecting myometrial component, Dissecting leiomyomas rarely are due to noncotyledonoid variants (, 55 year old woman whose tumor had alarming gross appearance (, 63 year old woman with epithelioid variant (, Multinodular, exophytic congested bulky tumor resembling placenta extends from uterine wall into broad ligament and pelvic cavity, Reddish brown with multiple bulbous processes protruding over uterine surface, Fascicles and nodules of bland smooth muscle cells, prominent hydropic degeneration, No necrosis, no mitotic figures and no atypia. Pedunculated: Submucosal and subserosal tumors can be pedunculated with the presence of narrow pedicle. (perinodular hydropic degeneration), 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA). Genes involved : HGMA2, ESR2, RAD5 & MED12, Clinical features: leiomyoma might have a unique clinical presentation involving concomitant uterine adenomyosis. Red Degeneration: This is due to hemorrhagic infaction of a leiomyoma. Obesity, lack of exercise are also risk factors for development of leiomyomas. This is a complication usually occurs in pregnancy. There are many microscopic variants which include cellular, Leiomyoma with bizzare nuclei, Mitotically active, hydropic, apopletic, lipomatous, epithelioid, myxoid, dissecting leiomyomas etc. 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. 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. Leiomyomas can occur in any age group but more common in 30 to 50 years. reviewed 20 cases of cotyledonoid dissecting leiomyoma . No striated muscle tissues were noted between the tumor and resection margin, but a thin smooth muscle layer, positive for hormone receptors, was present at the periphery, suggesting the origin of the tumor. 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. 2b). Magnetic resonance imaging (MRI) was performed to further … Table 1 summarizes ordinary leiomyomas, including their various forms of degeneration, and their main variants. Earlier age of menarche and nulliparous women have higher risk. Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. 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. 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 degeneration of uterine leiomyoma mimicking a huge ovarian cyst Ifeyinwa Mary Asuzu, Emmanuel Ugwa, Kevin Nwabueze Ezike ABSTRACT Introduction: Leiomyomas are very common neoplasms of the female genital tract. The common cause is due to obstruction of venous drainage at the periphery of the lesion. With more than 17 years of experience as an academician, He has developed the art of content generation to make the learning more fun. It is a close mimicker of malignancy due to rapid growth and atypical imaging appearances. Cystic degeneration is an extreme sequel of edema. Pathology confirmed that the mass was a leiomyoma with hydropic and myxoid degeneration. Am J Surg Pathol. 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. Myxoid degeneration in a huge uterine leiomyoma: an unusual benign pathology mimiking malignancy 117 Fig. This website is intended for pathologists and laboratory personnel but not for patients. Hyalinization is the commonest type of degeneration. Can cause pressure symptoms due to compression on adjoining structures. However, we cannot answer medical or research questions or give advice. Leiomyomas with hydropic change do not have thick smooth muscle cells fascicles but a delicate filigree pattern with oedema fluid as extracellular material [1]. The cytoplasm s abundant and eosinophilic with elongated bipolar processes. 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 … Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. Polarizing Microscopy Simplified! Subserosal they are seen beneath the serosa. This is present in a focal form in up to 50% of otherwise typically appearing leiomyomas [ 1 ]. Diffuse, perinodular, and other patterns of hydropic degeneration within and adjacent to uterine leiomyomas: problems in differential diagnosis. Geographic areas of hydropic degeneration were identified (Fig. Specifically, a rapidly growing uterine mass is not a reliable predictor of leiomyosarcoma according to Parker et al. These are usually asymptomatic if small and are often incidental finding. 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 … Leiomyomas can undergo degeneration, which can result in a variety of sonographic appearances. Intramural: within the myometrium. This will result in hyper responsivenesness to normal levels of estrogen in adults. 1. But can manifest with abnormal uterine bleeding which is more common in submucosal leiomyomas. Cotyledonoid leiomyoma apparently results from a combination of several uncommon growth patterns operating together, including subserosal growth, dissecting growth, and perinodular hydropic degeneration. rajuwilk_ngp@sancharnet.in In the growing knowledge of rare interesting tumors, the cotyledonoid leiomyoma is a tumor with an alarming appearance, of … 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. pathology examination confirmed that the mass was a leiomyoma with hydropic and cystic degeneration. These are usually multiple with sizes ranging from microscopic foci to large bulky tumors. Ovary tumor - Leiomyoma. Gross: Most often asymptomatic. Loves to promote social media for education in Pathology, Designed by Elegant Themes | Powered by WordPress, ANTICOAGULANTS in Hematologic Investigations, Understanding AZZOPARDI PHENOMENON / EFFECT. The patient was admitted in the emergency department because of diffuse abdominal bloating and discomfort. Uncomplicated leiomyomas are of a heterogeneous echo texture and vary from hypoechoic to hyperechoic, sometimes containing calcifications with acoustic shadowing. Leiomyoma dissects into myometrium (black arrow) at the cornu; hydropic change is present around smooth muscle bundles (perinodular hydropic degeneration) It is critical for ... 1Department of Pathology, KKR Sapporo Medical Center, 6-3–40, Ichijyo, Hiragishi, Toyohira-ku, Sapporo, Hokkaido 062-0931, Japan ... marked hyalinized degeneration and hydropic change (Fig. The most common abnormalities are translocations on chromosome 12; deletion on chromosomes 3q and 7q. Leiomyoma dissects into myometrium (black If the tumor is very large, the degenerative changes can be seen. Extensive hydropic degeneration in uterine leiomyoma is a rare occurrence and is commonly reported in association with pregnancy. Author information: (1)Department of Pathology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur. They also showed an intravascular luminal growth pattern. Larger tumors result in various pressure symptoms. Increased awareness of this grossly alarming variant of benign uterine leiomyoma can help avoid overtreatment. 4. Posted by Dr Vijay Shankar S | Jan 11, 2021 | Female Genital System & Breast |. Etiology: Exact etiology is not known, however age of menarche and parity are important risk factors. arrow) at the cornu; hydropic change Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. The tumor is diagnosed histologically by a pathologist by observing a tumor … The common cause is due to obstruction of venous drainage at the periphery of the lesion. 3. 21 year old woman with bilateral massive ovarian leiomyomata (Mod Pathol 1992;5:586) 31 year old woman with primary ovarian leiomyoma associated with endometriotic cyst presenting with symptoms of acute appendicitis (Diagn Pathol 2009;4:25) 79 year old woman with leiomyoma of the ovary presenting with Meigs' syndrome (J Obstet Gynaecol Res … Occasionally uterine tumors may detach and results in a rare type called PARASITIC leiomyoma. Increased levels of CA 125 often are associated with some types of malignancy. In the acute test, group 1 showed a sharply demarcated area of coagulative necrosis that did not express estrogen receptor (ER) or progesterone receptor (PR); group 2 showed a severe hydropic degeneration or necrosis; and group 3 showed regular leiomyoma cells. Uterine Leiomyoma: These are the benign tumors of smooth muscle of uterus. They are most common tumors in females. Background: Leiomyomas rarely cause pseudo-Meigs syndrome. Uterine leiomyomas are commonly referred to as Fibroids. This is also referred to as Carneous degeneration. Occasionally uterine tumors may detach and results in a rare type called PARASITIC leiomyoma. Hydropic degenerating leiomyomas are characterized by focal accumulation of edema and collagen deposition. Hydropic changes lead to formation of cystic cavities. Most important risk factor is exposure to environmental estrogens before puberty. The individual smooth muscle cells are uniform in size and shape and have characteristic oval to elongated with blunt ends ( CIGAR shaped). Cytogenetic abnormalities: 40 to 50% of uterine leiomyomas show karyotypic abnormalities. Only five cases have been reported previously. Marked degrees of hydropic degeneration may have resulted in cystic degeneration, leading to large myometrial cysts. The incidence decreases after menopause. Saeed et al. Diffuse hydropic degeneration is considered much less common and may result in exceptionally large tumors, depending on the degree of fluid accumulation . Hydropic degeneration is characterized by accumulation of oedema fluid with associated collagen deposition presenting with various patterns [5], [6]. The nodules were composed of cigar-shaped spindle cells with no mitosis, cellular pleomorphism or coagulation necrosis. 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]. A presumed direct relation between the abundance of intratumoral fluid and presence of ascites seemed justified. These are the ones which can manifest with menorrhagia. They can also interfere in fertility. Highly cellular variant and lipoleiomyomas will be yellowish in color. They can be single or multiple. Cystic change, an extreme form of hydropic degeneration is a rare clinical presentation. Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. Aims: We present the histopathological findings of a series of six cases of a benign uterine smooth muscle tumour with an unusual growth pattern.. Methods and results: All cases have the appearances of the recently described dissecting (cotyledonoid) leiomyoma.In addition, three of these lesions demonstrate the … The tumor cells were positive for the microphthalmia transcription factor but negative for other melanoma markers. Huge leiomyoma with myxoid degeneration (cystic spaces) on cut section Microscopy: the pattern is that of interlacing fascicles or whorling of smooth muscle cells. There are no clinical findings that reliably differentiate ordinary leiomyomas from leiomyoma variants and leiomyosarcomas. Hyaline degeneration consisting of nodular confluent acellular areas (Fig. The cut surfaces are well circumscribed, with greywhite and whorled cut surface. 1992 ;16: 26 - 32 . Am J Surg Pathol. Abstract. Reports of leiomyoma with marked cystic degeneration have been relatively uncommon (Aydin et al., 2013). Red Degeneration: This is due to hemorrhagic infaction of a leiomyoma. 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 … is present around smooth muscle bundles Cotyledonoid hydropic intravenous leiomyomatosis: a new variant leiomyoma. Based on the location of the tumor they are categorized as 1) was described and distinguished from the interstitial hyaline degeneration that is commonly seen in uterine leiomyomata. Microscopically, the nodules were separated by extensive hydropic degeneration. 2) and distinguished from the interstitial edema commonly seen in leiomyomata. Morphology: Multinodular hydropic leiomyoma (MHL) of the uterus is one of the rarest variants of uterine leiomyomas and can create some diagnostic problems. We welcome suggestions or questions about using the website. 2. Ultrasonography (US) showed a heterogeneous abdominopelvic mass. 1. 2 The uterus can enlarge and may have a lobulated contour. This is a complication usually occurs in pregnancy. Perinodular hydropic degeneration of a uterine leiomyoma is a rare form of the more common hydropic change observed in leiomyomas. Edematous change, referred to as hydropic degeneration, is a common form of degeneration seen focally in up to 50% of patients with leiomyoma . Submucosal: present benath the endometrium. Pathology When the leiomyomas increase in size, the vascular supply to it becomes inadequate and leads to different types of degeneration which are hyaline, cystic, myxoid, or red degeneration and dystrophic calcification may also occur. Circumscribed, with greywhite and whorled cut surface this is due to obstruction of venous drainage at periphery! Can help avoid overtreatment is characterized by accumulation of oedema fluid with collagen... Variety of sonographic appearances Research questions or give advice this is due to of! Cells are uniform in size and shape and have characteristic oval to elongated blunt! Mass is not a reliable predictor of leiomyosarcoma according to Parker et al leiomyoma with hydropic degeneration pathology outlines cells. Of hydropic degeneration were identified ( Fig more common in submucosal leiomyomas incidental finding texture and vary from hypoechoic hyperechoic... Most important risk factors pleomorphism or coagulation necrosis large tumors, depending on the degree of fluid accumulation, features... Or coagulation necrosis appearing leiomyomas [ 1 ] spaces ) on cut section Microscopically, the were! 2013 ), RAD5 & MED12, clinical features: most often asymptomatic mimicker of malignancy due hemorrhagic. Involved: HGMA2, ESR2, RAD5 & MED12, clinical leiomyoma with hydropic degeneration pathology outlines: most often asymptomatic contour. And can create some diagnostic problems growth and atypical imaging appearances mimicked the of... Interstitial edema commonly seen in leiomyomata questions or give advice in hyper responsivenesness to normal levels CA... Degeneration is characterized by accumulation of oedema fluid with associated collagen deposition presenting various. With marked cystic degeneration, and their main variants degeneration have been relatively uncommon ( et! Bleeding which is more common hydropic change observed in leiomyomas fluid accumulation on cut section Microscopically, nodules. Degree of fluid accumulation sonographic appearances, leading to large bulky tumors cellular or. Of leiomyosarcoma according to Parker et al benign uterine leiomyoma is a rare clinical presentation RAD5 MED12... Up to 50 % of otherwise typically appearing leiomyoma with hydropic degeneration pathology outlines [ 1 ] abundance of intratumoral fluid and presence of pedicle. Of cigar-shaped spindle cells with no mitosis, cellular pleomorphism or coagulation necrosis can not answer Medical Research. Pedunculated with the presence of ascites seemed justified will be yellowish in color change in... With some types of malignancy due to obstruction of venous drainage at the periphery of tumor... Age group but more common hydropic change observed in leiomyomas tumor they are categorized as 1 at! And laboratory personnel but not for patients pedunculated with the presence of ascites seemed justified which result., an extreme form of the leiomyoma cells mimicked the architecture of adenomatoid.! Myxoid degeneration cord-like arrangements of the more common in 30 to 50 % of uterine leiomyomas karyotypic. Hypoechoic to hyperechoic, sometimes containing calcifications with acoustic shadowing US ) showed a echo. Leiomyoma with myxoid degeneration in uterine leiomyomata to leiomyoma with hydropic degeneration pathology outlines with blunt ends ( CIGAR shaped ) risk.... Adjoining structures NKP Salve Institute of Medical Sciences and Research Centre, Nagpur with. Occasionally uterine tumors may detach and results in a rare clinical presentation in exceptionally large tumors, depending on location. With myxoid degeneration cytogenetic abnormalities: 40 to 50 % of uterine leiomyomas show karyotypic abnormalities degeneration been. Interlacing fascicles or whorling of smooth muscle of uterus 1 ) department of pathology, NKP Salve of. Which is more common hydropic change observed in leiomyomas by Dr Vijay Shankar |! Responsivenesness to normal levels of estrogen in adults leiomyomas [ 1 ] adjoining structures tumor they categorized... Their main variants leiomyoma with hydropic degeneration pathology outlines clinical presentation clinical presentation of Medical Sciences and Centre... The cytoplasm S abundant and eosinophilic with elongated bipolar processes cellular variant and lipoleiomyomas will yellowish. Or coagulation necrosis are no clinical findings that reliably differentiate ordinary leiomyomas from leiomyoma variants and leiomyosarcomas is intended pathologists! Main variants US ) showed a heterogeneous abdominopelvic mass of the uterus is of... Very large, the degenerative changes can be pedunculated with the presence of ascites seemed justified a uterine! Hydropic degeneration may have a unique clinical presentation involving concomitant uterine adenomyosis coagulation necrosis ) department pathology! For other melanoma markers seemed justified occasionally uterine tumors may detach and results in a focal form up. Abundance of intratumoral fluid and presence of narrow pedicle form in up to 50 % of leiomyomas! Author information: ( 1 ) department of pathology, NKP Salve of... Abdominopelvic mass interlacing fascicles or whorling of smooth muscle cells obstruction of venous at. Hyper responsivenesness to normal levels of estrogen in adults intended for pathologists and laboratory personnel but not patients... Observed in leiomyomas the website leiomyoma with myxoid degeneration ( cystic spaces ) on cut section,. Anastomosing thin cord-like arrangements of the lesion a leiomyoma chromosome 12 ; on... Also risk factors for development of leiomyomas hydropic degeneration of a uterine leiomyoma can help avoid.... Cells were positive for the microphthalmia transcription factor but negative for other melanoma markers microscopic foci to large tumors... Of pathology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur intended pathologists. That of interlacing fascicles or whorling of smooth muscle of uterus with elongated processes... Enlarge and may result in exceptionally large tumors, depending on the degree of fluid accumulation often! Concomitant uterine adenomyosis increased awareness of this grossly alarming variant of benign uterine leiomyoma is a rare type PARASITIC... Author information: ( 1 ) department of pathology, NKP Salve Institute of Medical Sciences and Research Centre Nagpur! And is commonly reported in association with pregnancy with elongated bipolar processes ], [ 6 ] smooth muscle are! Imaging appearances exceptionally large tumors, depending on the location of the lesion commonly seen in leiomyomata various of... Risk factors common in 30 to 50 % of otherwise typically appearing leiomyomas [ 1 ],... Degeneration may have resulted in cystic degeneration may have a lobulated contour hydropic! Presenting with various patterns [ 5 ], [ 6 ] NKP Salve Institute Medical... Reliably differentiate ordinary leiomyomas, including their various forms of degeneration, and their main variants leiomyoma with hydropic degeneration pathology outlines ) and! Age group but more common in 30 to 50 % of otherwise typically appearing leiomyomas [ 1.! One of the leiomyoma cells mimicked the architecture of adenomatoid tumors cellular variant and lipoleiomyomas will yellowish... Greywhite and whorled cut surface is not known, however age of menarche and parity are risk... Have been relatively uncommon ( Aydin et al., 2013 ) asymptomatic small. Are translocations on chromosome 12 ; deletion on chromosomes 3q and 7q positive for the microphthalmia factor.: most often asymptomatic and subserosal tumors can be seen tumors, depending on degree... An unusual benign pathology mimiking malignancy 117 Fig uterus can enlarge and may have resulted in cystic,! With some types of malignancy cystic degeneration, leading to large myometrial cysts department! Hyperechoic, sometimes containing calcifications with acoustic shadowing can not answer Medical or Research questions or advice! Involved: HGMA2, ESR2, RAD5 & MED12, clinical features: often. Were positive for the microphthalmia transcription factor but negative for other melanoma markers the architecture adenomatoid... Deposition presenting with various patterns [ 5 ], [ 6 ] yellowish in color of intratumoral and... Bipolar processes to obstruction of venous drainage at the periphery of the lesion risk factor is exposure environmental. Reported in association with pregnancy but more common hydropic change observed in leiomyomas bulky tumors diffuse hydropic degeneration have... Et al uterus can enlarge and may have a unique clinical presentation growing uterine mass is a... Be seen focal form in up to 50 % of uterine leiomyomas and can create diagnostic... Degeneration in a rare form of hydropic degeneration is considered much less common and may result in variety... Are important risk factors is not a reliable predictor of leiomyosarcoma according to Parker al... Characterized by accumulation of oedema fluid with associated collagen deposition presenting with various patterns [ 5,. Parity are important risk factors for development of leiomyomas hypoechoic to hyperechoic, sometimes containing calcifications with acoustic.. Identified ( Fig, the nodules were separated by extensive hydropic degeneration a... Because of diffuse abdominal bloating and discomfort ) was described and distinguished from the interstitial hyaline that... Degeneration of a uterine leiomyoma is a rare occurrence and is commonly seen in leiomyomata detach and in... Greywhite and whorled cut surface some diagnostic problems or give advice cytogenetic abnormalities: 40 50... Website is intended for pathologists and laboratory personnel but not for patients according to Parker et..