Giant leiomyoma with bizarre nuclei

Forty-nine-year-old woman with progressive increase in abdominal perimeter, dyspnoea and oedema in the lower limbs. Computed tomography (Fig. 1) revealed a large multiseptated cystic mass displacing intra-abdominal organs. Intraoperatively, a cystic tumour adherent to the uterus and mesosigm with no clear organ dependence was confirmed (Fig. 2); en bloc resection with hysterectomy and sigmoidectomy was performed and it turned out to be a leiomyoma with bizarre nuclei of probable uterine origin (Fig. 3).

Fig. 1

Fig. 2

Fig. 3

Leiomyoma with bizarre nuclei is a rare benign variant of smooth muscle neoplasia, and is considered a distinct entity by the WHO 2014 classification. It presents features of histological atypia, requiring differential diagnosis with leiomyosarcoma.

Diagnosis

Leiomyoma with bizarre nuclei.