Cellular leiomyoma: A 10-year retrospective analysis of clinical features, and recurrence risk

In this study, we aimed to compare the clinical characteristics of cellular leiomyoma (CL) with those of typical uterine leiomyoma (UL) and explore recurrence risk factors in patients with CL myomectomy.

In this retrospective cohort study, we analyzed medical records of patients diagnosed with CL (n = 102) and UL (n = 105) who underwent surgery between January 2013 and May 2023. Postoperative prognosis was assessed through patient follow-up until June 2024.

Patients with CL were likelier to have adenomyosis (odds ratio [OR], 4.06; 95% confidence interval [CI], 1.28-12.88; p = 0.017) and late-age menarche (OR, 1.50; 95% CI, 1.15-1.95; p = 0.002). A uterus that has three or fewer fibroids (OR, 2.14; 95% CI, 1.05-4.37; p = 0.037) was more likely to develop into CL than the control group. Concerning the predictive aspect, more than three fibroids are associated with a higher risk of recurrence (OR, 5.33; 95% CI, 1.02-27.76; p = 0.047). The use of hysteroscopy to remove submucosal fibroids is associated with a lower risk (OR, 0.08; 95% CI, 0.01-0.78; p = 0.030).

This study confirms that CL exhibits distinct clinical characteristics from ULs, with a higher postoperative recurrence rate and risks of malignant transformation and abdominal dissemination. Our study identified for the first time that adenomyosis is an independent risk factor for CL. Additionally, submucous fibroids tend to be resected while still small, allowing for more complete removal and reducing recurrence risk. An increased number of fibroids was also identified as a risk factor for recurrence.