Abstract
After performing laparoscopic unilateral adnexectomy in a 53-year-old woman for a rapidly grown unilateral adnexal mass, pathologists reported a primary ovarian leiomyoma with no genuine ovarian tissue. This rare diagnosis is found in less than 100 reports after systematic literature review, a greater number of asymptomatic ovarian leiomyomas can be expected. Thorough preoperative diagnostic measures are essential as rare cases of malignancy have been described.
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Leiomyomas typically appear in the uterus but can also form in rare other locations as shown in this case, so this highlights the importance to consider a myoma as a diffenrential diagnosis for tumours of uncertain dignity. |
Presentation
A 53-year-old postmenopausal woman was referred to our tertiary referral university hospital with a rapidly grown unilateral adnexal mass and abnormal sonogram. She experienced no specific symptoms or discomfort, CA-125 level was normal. We carried out IOTA ADNEX model-sonography and estimated a 95% probability for benignity with suspected ovarian fibroma (Fig. 1a). Laparoscopic unilateral adnexectomy was performed. The ovary presented with an uneven but smooth surface with increased vascularity (Fig. 1b). Postoperative recovery was normal. The pathology report described a primary ovarian leiomyoma with no genuine ovarian tissue.
a IOTA-Sonogram of left adnex, b Laparoscopic image of the primary ovarian leiomyoma (<) with adjacent left fallopian tube (*) and uterus (x)
Discussion: systematic literature review revealed less than 100 reports of primary ovarian leiomyomas, with some cases finding residual ovarian tissue [1, 2]. Up to 85% of cases are found in premenopausal women [3]. Presentation mainly occurs due to symptoms like unilateral lower abdominal pain with palpable mass or menstrual disorders. Sonograms usually show large tumours measuring 5–15 cm with normal CA-125. Smooth muscle cells of the hilum vessels are discussed to be the origin [2], a greater number of undiagnosed small, asymptomatic ovarian leiomyomas can be expected. Thorough preoperative diagnostic measures are essential as cases of malignant primary ovarian leiomyosarcoma (POLMS) have been described [4].
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References
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Hashimoto S, Taga M, Endoh M, Ikeda M, Shirasu K, Uemura T, Hara M, Minaguchi H (1997) Leiomyomas of the uterus, ovary and vaginal wall. A case report. Gynecol Obstet Invest 44:275–277. https://doi.org/10.1159/000291543
Cavkaytar S, Karaer A, Ozbagi T (2010) Primary ovarian leiomyoma in a postmenopausal woman. J Obstet Gynaecol 30:746–747. https://doi.org/10.3109/01443615.2010.501924
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All authors contributed to the study conception and design. Material preparation, data collection and literature review were performed by MP and MB-P. The first draft of the manuscript was written by MP, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Pervan, M., Gembicki, M., Princk, H. et al. Primary ovarian leiomyoma: a rare ovarian tumour. Arch Gynecol Obstet 308, 1379–1380 (2023). https://doi.org/10.1007/s00404-022-06842-4
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DOI: https://doi.org/10.1007/s00404-022-06842-4