DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175293

A bizarre highly vascular tumor with alarming presentation: a diagnostic dilemma

Kamal Buckshee, Rastogi Harsh, Arora Deepshikha, Rohatgi B. Tanya

Abstract


An exceedingly rare, highly vascular tumor with atypical and alarming presentation posed diagnostic and management challenges. A 29 years old lady, complained of abdominal and pelvic pain, nausea, vomiting and repeated spells of fainting attacks following the jumping episode (2-3 times). Emergency admission and investigations at United States of America (USA) revealed a large, complex, highly vascular, irregular mass displaying finger like projections, filling the lower abdomen, pelvis and large amount of intra peritoneal bleed. A provisional diagnosis of arteriovenous malformation (AVM), arteriovenous fistula (AVF), and rupture/leak was made. Uterine artery angiography (UAA), preoperative embolization and possibility of hysterectomy as a life saving measure were suggested, to which the couple declined and got discharged. To save uterus and fertility they presented to us for second opinion and further management. Angiography, magnetic resonance imaging (MRI) and preoperative uterine artery embolization were done followed by exploratory laparotomy which revealed hemoperitoneum and a large weird looking vascular tumor (a veil of sea weeds/dark purple nodules of various sizes resembling cotyledons of placenta). Intra-operative tissue analysis (frozen section) suggested benign pathology. Mass was removed completely and fertility sparing surgery was undertaken. Histopathological diagnosis was cotyledonoid dissecting leiomyoma (CDL). No recurrence/metastasis has been observed on follow up of 5 years.


Keywords


Cotyledonoid dissecting leiomyoma, Uterine artery angiography, Uterine artery embolization

Full Text:

PDF

References


Roth LM, Reed RJ, Sternberg WH. Cotyledonoid dissecting leiomyoma of the uterus: the Sternberg tumor. Am J Surg Pathol. 1996;20(12):455-61.

Smith CC, Gold MA, Wile G, Fadare O. Cotyledonoid dissecting leiomyoma of the uterus: a review of clinical, pathological, and radiological features. Int J Surg Pathol. 2012;20(4):330-41.

Xu T, Wu S, Yang R, Zhao L, Sui M, Cui M, et al. Cotyledonoid dissecting leiomyoma of the uterus: a report of four cases and a review of the literature. Oncology Letters. 2016;11(4):2865-8

Menolascino-Brrata F, de Barriola GV, de Gomez NM, Tamayo GJ, Suarez JA, Chacon HAV. Cotyledonoid dissecting leiomyoma (Sternberg tumor): an unusual form of leiomyoma. Pathol Res Pract. 1999;195(6):435-8.

Preda L, Rizzo S, Gorone MS, Fasani R, Maggioni A, Bellomi M. MRI features of cotyledonoid dissecting leiomyoma of the uterus. Tumori. 2009;95(4):532-4.

Weissferdt A, Maheshwari MB, Downey GP, Rollason TP, Ganesan R. Cotyledonoid dissecting leiomyoma of the uterus: a case report. Diagn Pathol. 2007;2:18.

Roth LM, Kirker JA, Insull M, Whittaker J. Recurrent cotyledonoid dissecting leiomyoma of the uterus. Int J Gynecol Pathol. 2013;32:215-20.