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Cotyledonoid Dissecting Leiomyoma with Symplastic Features: Case Report.
Fatma Cavide Sonmez1, Zeynep Tosuner1, Ayse Filiz Gökmen Karasu2
1Department of Pathology, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
Summary
Cotyledonoid dissecting leiomyomas, a rare uterine tumor variant, can appear aggressive but are benign. This report details atypical cells, previously undocumented in this leiomyoma type.
Area of Science:
- Gynecologic pathology
- Surgical pathology
- Uterine neoplasms
Background:
- Cotyledonoid dissecting leiomyoma is a rare variant of uterine leiomyoma.
- This variant exhibits unusual gross and histological growth patterns.
- Understanding its characteristics is crucial for accurate diagnosis and patient management.
Observation:
- A case of cotyledonoid dissecting leiomyoma presented as a congested, multinodular myomectomy specimen.
- Histological examination revealed marked vascularity, extensive hydropic degeneration, and atypical bizarre cells.
- Low mitotic activity (2 per 10 HPF) and Ki-67 index (2-3%) were noted, with no coagulative necrosis.
Findings:
- The presence of atypical bizarre cells is a novel finding in cotyledonoid dissecting leiomyomas.
- Despite a potentially aggressive gross appearance, the tumor demonstrated benign histological features.
- The patient remained recurrence-free 36 months post-surgery.
Implications:
- Cotyledonoid dissecting leiomyomas, including those with atypical cells, are clinically benign.
- Pathologists and surgeons must be aware of this leiomyoma variant to avoid misdiagnosis.
- Recognition of symplastic features is key to differentiating benign from malignant uterine tumors.
