Takeda Akihiro, Imoto Sanae, Mori Masahiko, Nakamura Hiromi
Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Maebata-cho 5-161, Tajimi, Gifu, 507-8522, Japan.
J Med Case Rep. 2011 Aug 3;5:344. doi: 10.1186/1752-1947-5-344.
Bizarre leiomyoma is a rare leiomyoma variant that requires a precise histopathological evaluation. Especially when diagnosed in a younger woman, this tumor leads to challenging treatment issues involving fertility preservation. Owing to the low incidence of bizarre leiomyoma, there is insufficient evidence to support myomectomy alone as an appropriate management option. Also, the impact of bizarre leiomyoma on fertility is not well known.
A 30-year-old Japanese woman who had never given birth was referred to us because of a uterine tumor with an unusual diagnostic image and was treated by a gasless laparoscopic-assisted excision with a wound retractor. Owing to an unclear margin between her uterine tumor and myometrium, a concomitant excision of adjacent myometrial tissue was required to achieve the maximum resection of her tumor. The histopathological diagnosis was bizarre leiomyoma. Seven months later, she conceived spontaneously and her pregnancy course was uneventful. At 37 weeks of gestation, an elective cesarean section was performed. Although a slight omental adhesion was noted at the postexcisional scar, her uterine wall structure was well preserved and a recurrence of bizarre leiomyoma was not noted.
A laparoscopic-assisted excision of bizarre leiomyoma is a feasible and minimally invasive conservative measure for a woman who wishes to preserve fertility.
奇异平滑肌瘤是一种罕见的平滑肌瘤变异型，需要进行精确的组织病理学评估。尤其是在年轻女性中诊断出这种肿瘤时，会引发涉及生育力保留的具有挑战性的治疗问题。由于奇异平滑肌瘤的发病率较低，没有足够的证据支持单独行子宫肌瘤切除术作为一种合适的治疗选择。此外，奇异平滑肌瘤对生育力的影响尚不明确。
一名30岁未生育的日本女性因子宫肿瘤具有不寻常的诊断影像被转诊至我院，并接受了使用伤口牵开器的无气腹腔镜辅助切除术。由于其子宫肿瘤与肌层之间的边界不清晰，需要同时切除相邻的肌层组织以实现肿瘤的最大程度切除。组织病理学诊断为奇异平滑肌瘤。七个月后，她自然受孕，孕期过程顺利。妊娠37周时，进行了择期剖宫产。尽管在切除术后瘢痕处发现了轻微的网膜粘连，但她的子宫壁结构保存良好，未发现奇异平滑肌瘤复发。
对于希望保留生育力的女性，腹腔镜辅助切除奇异平滑肌瘤是一种可行的微创保守措施。
