Retroperitoneal Hydropic Leiomyoma Mimicking an Ovarian Cyst

A report describes a case of a 46-year-old gravida 0 woman who came for a hydrosalpinx that she incidentally found a month ago. She was asymptomatic, without any complaints or discomfort. She had no significant comorbidities or a family history of gynecological diseases. 

Her Transvaginal sonography showed a right adnexal complex mass of 8.1* 3.8 cm that did not resolve after three months of expectant management. Her cancer antigen 125 (CA 125) and 19-9, and carcinoembryonic antigen levels, were within normal limits. 

Abdominal computed tomography (CT) revealed a mass with solid and cystic components in the right pelvic cavity, compressing and displacing her anteverted uterine body to the left side. The pelvic cavity and para-aortic regions showed no enlarged lymph nodes.

She underwent a laparoendoscopic single-site surgery for exploration and excision of the tumor. The treating physicians also planned a possible staging surgery in case of malignancy. The surgical procedure revealed a retroperitoneal cystic tumor in the right retroperitoneal cavity. The tumor was grayish-white in colour and grossly elastic. Microscopic examinations showed infarction and hydropic degeneration of the leiomyoma. It was moderately cellular without nuclear atypia or coagulative necrosis and with rare mitotic figures. She received a definitive diagnosis of Hydropic leiomyoma (HLM). 

The patient recovered uneventfully with no remarkable lesions at follow-up transvaginal sonography. She did not report any recurrence so far.

Lai P-H, Ding D-C. Retroperitoneal Hydropic Leiomyoma Mimicking an Ovarian Cyst. Case Reports in Obstetrics and Gynecology. 2022;2022.

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