Cotyledonoid leiomyoma of the uterus

In the growing knowledge of rare interesting tumors, the cotyledonoid leiomyoma is a tumor with an alarming appearance, of benign nature, but dealt with undue severity. We report a case of cotyledonoid leiomyoma in a 40 yr old female who presented with urinary retention and in whom a clinical diagnosis of uterine fibroid was made. On laparotomy, friable nodules were seen in the lower part of the uterus. Hence the diagnosis of sarcoma was considered and total abdominal hysterectomy with unilateral salpingo-oopherectomy was done. The friable nodules were removed piecemeal. Microscopic examination revealed nodules of bland looking smooth muscle cells arranged in-interlacing fascicles with perinodular hydropic degeneration. Necrosis or nuclear atypia was not seen. Increased awareness of this grossly alarming variant of benign leiomyoma can help avoid over treatment.