Yorita Kenji, Tanaka Yu, Hirano Koki, Kuwahara Michio, Nakatani Kimiko, Fukunaga Masaharu, Agaimy Abbas
Department of Diagnostic Pathology Department of Obstetrics and Gynecology Department of Surgery Department of Radiology, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi Shin-Yurigaoka General Hospital, Kawasaki City, Kanagawa, Japan Institute of Pathology, University Hospital of Erlangen, Erlangen, Germany.
Medicine (Baltimore). 2017 Dec;96(48):e8971. doi: 10.1097/MD.0000000000008971.
Leiomyomas arising from the anterolateral abdominal wall are uncommon, and their pathogenesis remains unknown. We present the 15th case of such a tumor, having this unique tumor morphology, followed by a detailed discussion on disease pathogenesis.
A 48-year-old, asymptomatic perimenopausal, multiparous Japanese woman presented with a left-sided pelvic mass. She had no history of previous surgeries or uterine leiomyomas. Although a transabdominal ultrasonogram raised suspicions of an ovarian tumor, a transvaginal ultrasonogram confirmed normal ovaries. Radiological images showed a multilocular cystic mass with enhanced solid lesions connected to the uterus. Retrospective radiological evaluation showed that the mass was largely connected to the peritoneum of the anterolateral abdominal wall.
Intraoperatively, the mass appeared as a dome-like protrusion from the left lower quadrant of the abdominal wall, without connection to the uterus, ovaries, or the left round ligament. No other peritoneal masses were seen. The mass was easily enucleated from the abdominal wall. Pathology confirmed that the mass was a leiomyoma with hydropic and myxoid degeneration. No striated muscle tissues were noted between the tumor and resection margin, but a thin smooth muscle layer, positive for hormone receptors, was present at the periphery, suggesting the origin of the tumor.
Benign leiomyomas of the anterolateral abdominal wall likely originate from Müllerian-like smooth muscle remnants in this region. They should be considered in the differential diagnosis of solid and cystic masses and be distinguished from uterine and ovarian masses on imaging to avoid unnecessary organ resection.
起源于腹壁前外侧的平滑肌瘤并不常见，其发病机制尚不清楚。我们报告了第15例具有这种独特肿瘤形态的此类肿瘤病例，并对疾病发病机制进行了详细讨论。
一名48岁、无症状的围绝经期、经产妇日本女性，出现左侧盆腔肿块。她既往无手术史或子宫平滑肌瘤病史。虽然经腹超声检查怀疑为卵巢肿瘤，但经阴道超声检查证实卵巢正常。影像学图像显示为多房囊性肿块，伴有与子宫相连的强化实性病变。回顾性影像学评估显示，该肿块主要与腹壁前外侧的腹膜相连。
术中，肿块表现为从腹壁左下腹呈圆顶状突出，与子宫、卵巢或左圆韧带无连接。未见其他腹膜肿块。该肿块很容易从腹壁摘除。病理证实肿块为伴有水肿和黏液样变性的平滑肌瘤。肿瘤与切除边缘之间未见横纹肌组织，但周边有一层薄的、激素受体阳性的平滑肌层，提示肿瘤的起源。
腹壁前外侧的良性平滑肌瘤可能起源于该区域类似苗勒管的平滑肌残余组织。在实性和囊性肿块的鉴别诊断中应考虑到它们，并在影像学上与子宫和卵巢肿块相区分，以避免不必要的器官切除。
