Variant type of leiomyomas: 13 years of experience in a single institution

Our understanding of a variant type of leiomyoma lags far behind of leiomyoma/leiomyosarcoma of the uterus. The rarity of variant type leiomyomas limits epidemiologic study, evidence-based guidance for diagnosis and treatment. We aimed to analyze clinical, pathologic and radiological features of variant type of leiomyomas in women who underwent surgical therapy for symptomatic disease in a tertiary center. We furthermore intended to put forth the recurrence patterns of variant type of leiomyoma after uterine-conserving therapies.

Pathology results and inpatient files of women undergoing surgery (vaginal or abdominal hysterectomy; total abdominal hysterectomy and bilateral salphingoopherectomy; abdominal myomectomy; polipectomy) for symptomatic disease and with a histologic diagnosis of variant type of leiomyoma were assessed. Patient gravida, parity, menopausal status, patient complaint, type of initial surgical procedure, size of neoplasms, number of mitosis, presence of atypia, and necrosis, MRI evaluation, recurrence and any subsequent therapy were documented.

A total of 3275 patients' medical records were evaluated between 2005-2018. The study sample comprised of 185 women with a diagnosis of variant type of leiomyoma. The patients ranged from 23 to 79 years of age. One hundred thirty-five cases were postmenopausal and 50 cases were during the reproductive period. The most common presenting symptom was menometrorrhagia (38.9%). Four point nine percent of cellular leiomyoma, 14.2% of smooth muscle tumors of uncertain malignant potential (STUMP) and 4.7% of atypical leiomyomas were recurred with clinical follow-up.

Clinicians should be aware of variant type leiomyomas and their associated clinical, imaging, and pathologic issues.