Onu David O, Fiorentino Lisa M, Bunting Michael W
Department of Gynaecological Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
BMJ Case Rep. 2013 Oct 11;2013:bcr2013201350. doi: 10.1136/bcr-2013-201350.
Uterine fibroids having the distinct pathological and immunohistochemical features of cotyledonoid dissecting leiomyoma have been reported infrequently. We describe a postmenopausal woman with an incidental finding of an abdominopelvic mass arising from the uterine fundus on routine radiological imaging of the lumbar spine. The imaging was performed for the investigation of chronic radicular lower back pain refractory to usual pain management. However, the woman did not manifest any gynaecological symptoms. Intraoperatively, the pelvic mass appeared malignant and a frozen section suggested uterine sarcoma. As such, the mass was radically resected, resulting in significant resolution of the back pain. To the authors' knowledge, this is the first report of cotyledonoid dissecting leiomyoma presenting solely as chronic lower back pain, and also the first report of this fibroid variant in Australasia. We discuss the diagnostic and operative challenges, emphasising the role of radiological imaging and immunohistopathology in such cases and review current literature.
具有子叶状分割性平滑肌瘤独特病理和免疫组化特征的子宫肌瘤鲜有报道。我们描述了一名绝经后女性，在腰椎常规放射影像学检查时偶然发现子宫底部有一个腹盆腔肿物。此次影像学检查是为了调查对常规疼痛管理无效的慢性神经根性下背痛。然而，该女性未表现出任何妇科症状。术中，盆腔肿物看似恶性，冰冻切片提示子宫肉瘤。因此，该肿物被根治性切除，背痛得到显著缓解。据作者所知，这是首例仅表现为慢性下背痛的子叶状分割性平滑肌瘤报告，也是该肌瘤变体在澳大拉西亚地区的首例报告。我们讨论了诊断和手术挑战，强调了放射影像学和免疫组化在这类病例中的作用，并回顾了当前文献。
