DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20221455

Hydropic leiomyoma, a considerable differential diagnosis: a case series

El Hassan El Ghali, Jihane Meziyane, Soukaina Auragh, Hanane Saadi, Hafsa Taheri, Ahmed Mimouni

Abstract


Uterine leiomyomas can show a wide variety of degenerative changes. In the actual work, we report two cases of hydropic leiomyomas. Hydropic leiomyomas are characterized by a massive intra-tumoral accumulation of watery edema. This variant is often associated to atypical clinical and radiological presentations, raising the possibility of aggressive neoplasms, particularly uterine sarcomas. Although imaging can be helpful to diagnose uterine neoplasms, in particular ultrasounds and MRI, the radiological features of Hydropic leiomyomas, as for other leiomyomas variants, are often atypical and worrisome for uterine sarcomas. The pathological evaluation is often needed to have a final diagnosis.

 


Keywords


Leiomyoma, Hydropic leimyoma, Leiomyosarcoma

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References


Akkour K, Alhulwah M, Alqahtani N, Arafah MA. A Giant Leiomyoma with Massive Cystic Hydropic Degeneration Mimicking an Aggressive Neoplasm: A Challenging Case with a Literature Review. The American Journal of Case Reports. 2021;22(2):929085-1.

Awad EE, El-Agwany AS, Elhabashy AM, El-Zarka A, Moneim ASA. A giant uterine myometrium cyst mimicking an ovarian cyst in pregnancy: An uncommon presentation of hydropic degeneration of uterine fibroid. Egypt J Radiol Nucl Med. 2015;46(2):529-34.

Moore L, Wilson S, Rosen B. Giant hydropic uterine leiomyoma in pregnancy: Unusual sonographic and Doppler appearance. J Ultrasound Med. 1994;13(5):416-8.

Coard K, Plummer J. Massive multilocular cystic leiomyoma of the uterus: An extreme example of hydropic degeneration. South Med J. 2007;100(3):309-12.

Awad EE, El-Agwany AS, Elhabashy AM, El-Zarka A, Moneim ASA. A giant cystic leiomyoma mimicking an ovarian malignancy. Int J Surg Case Rep. 2013;4(11):1010-12.

Protopapas A, Milingos S, Markaki S, Loutradis D, Haidopoulos D, Sotiropoulou M et al. Cystic uterine tumors. Gynecol Obstet Invest. 2008;65(4):275-80.

Dancz CE, Macdonald HR. Massive cystic degeneration of a pedunculated leiomyoma. Fertil Steril. 2008;90(4):1180-81.

Heffernan E, Köbel M, Spielmann A. Case report: Hydropic leiomyoma of the uterus presenting in pregnancy: Imaging features. Br J Radiol. 2009;82(980):164-67.

Horta M, Cunha TM, Oliveira R, Magro P. Hydropic leiomyoma of the uterus presenting as a giant abdominal mass. BMJ Case Rep. 2015;2015:bcr2015211929.

Funaki K, Fukunishi H, Tsuji Y, Maeda T, Takahashi T. Giant cystic leiomyoma of the uterus occupying the retroperitoneal space. J Radiol Case Rep. 2013;7(12):35-40.

Kurman RJ, Carcangiu ML, Herrington CS, Young RH. Classification of tumours of the ovary. In: WHO classification of tumours. 4th edn. Lyon: IARC. 2014;6:135-41.

Rosai J. Rosai and Ackerman’s surgical pathology. 10 ed. Philadelphia (PA): Mosby Elsevier. 2011.

Clement PB, Young RH, Scully RE. Diffuse, perinodular, and other patterns of hydropic degeneration within and adjacent to uterine leiomyomas. Problems in differential diagnosis. Am J Surg Pathol. 1992;16(1):26-32.

Zaloudek CJ, Hendrickson MR, Soslow RA. Mesenchymal tumors of the uterus. In: Kurman RJ, Ellenson LH, Ronnett BM, editors. Blaustein’s pathology of the female genital tract. 6th ed. New York: Springer. 2011.

Coad JE, Sulaiman RA, Das K, Staley N. Perinodular hydropic degeneration of a uterine leiomyoma: A diagnostic challenge. Hum Pathol. 1997;28(2):249-51.

Grapsa D, Smyrniotis V, Hasiakos D, Kontogianni-Katsarou K, Kondi-Pafiti A. A giant uterine leiomyoma simulating an ovarian mass in a 16-year-old girl: A case report and review of the literature. Eur J Gynaecol Oncol. 2006;27(3):294-96.

Dunn Jr JS, Anderson CD, Method MW, Brost BC. Hydropic degenerating leiomyoma presenting as pseudo-Meigs syndrome with elevated CA 125. Obstet Gynecol. 1998;92(4):648-49.

Amant F, Gabriel C, Timmerman D, Vergote I. Pseudo-Meigs’ syndrome caused by a hydropic degenerating uterine leiomyoma with elevated CA 125. Gynecol Oncol. 2001;83(1):153-7.

Oguma T, Yamasaki N, Nakanishi K. Pseudo-Meigs’ syndrome associ- ated with hydropic degenerating uterine leiomyoma: A case report. J Obstet Gynaecol Res. 2014;40(4):1137-40.

Ludovisi M, Moro F, Pasciuto T. Imaging in gynecological disease (15): Clinicalandultrasound characteristics of uterine sarcoma. Ultrasound Obstet Gynecol. 2019;54(5):676-87.

Yamashita Y, Torashima M, Takahashi M. Hyperintense uterine leiomyoma atT2-weighted MR imaging: Differentiation with dynamic enhanced MR imaging and clinical implications. Radiology. 1993;189(3):721-25.

Mazziotti S, Ascenti G, Racchiusa S. Retroperitoneal growth of degenerated myxoid uterine leiomyoma mimicking sarcoma. Clin Radiol. 2012;67(6):616-7.

Awad EE, El-agwani AS, Elhabashy AM. A giant uterine myometrium cyst mimicking an ovarian cyst in pregnancy: an uncommon presentation of hydropic degeneration of uterine fibroid. Egypt J Radiol Nucl Med. 2015;46(2):529-34.

Thomassin-Naggara I, Dechoux S, Bonneau C. How to differentiate benign from malignant myometrial tumours using MR imaging. Eur Radiol. 2013;23(4):2306-14.

Griffin BB, Ban Y, Lu X. Hydropic leiomyoma: A distinct variant of leiomyoma closely related to HMGA2 overexpression. Hum Pathol. 2019;84:164-72.