Cotyledonoid dissecting leiomyoma with peritoneal dissemination

Area of Science:

• Gynecologic Oncology
• Surgical Pathology
• Reproductive Medicine

Background:

• Cotyledonoid dissecting leiomyoma (CDL) is a rare benign uterine neoplasm characterized by multinodular, placenta-like growth.
• CDL poses diagnostic challenges due to its unclear borders with the myometrium, often leading to misdiagnosis as uterine sarcoma.
• While generally having a good prognosis, CDL can rarely present with peritoneal dissemination.

Purpose of the Study:

• To report a case of CDL initially suspected as a subserosal myoma, necessitating a change in surgical management to total hysterectomy with resection of peritoneal dissemination.
• To conduct a literature review comparing CDL cases with and without peritoneal dissemination to identify predictive factors.

Main Methods:

• Case report of a patient diagnosed with CDL.
• Intraoperative histopathological diagnosis guiding surgical decisions.
• Systematic literature review of CDL cases, categorizing them based on the presence or absence of peritoneal dissemination.

Main Results:

• The patient underwent total hysterectomy with resection of peritoneal dissemination due to intraoperative findings and rapid histopathological diagnosis.
• Literature review revealed a statistically significant difference in tumor diameter between CDL cases with and without peritoneal dissemination.
• Tumor diameter was significantly greater in the group with peritoneal dissemination.

Conclusions:

• CDL requires careful preoperative and intraoperative assessment to avoid misdiagnosis and ensure appropriate surgical management.
• Larger tumor size is a potential risk factor for peritoneal dissemination in CDL.
• While fertility preservation may be considered in select CDL cases, the risk of dissemination in larger tumors warrants consideration.