Cystic Hydropic Leiomyoma Presenting as a Uterine Cystic Mass
Recommended Citation
Ndam F, Almukhtar R, Bandyopadhyay S, Salem N. Cystic Hydropic Leiomyoma Presenting as a Uterine Cystic Mass. Am J Clin Pathol 2025; 164:S79.
Document Type
Conference Proceeding
Publication Date
11-12-2025
Publication Title
Am J Clin Pathol
Keywords
hyalin, abdominal myomectomy, adult, case report, clinical article, conference abstract, controlled study, cyst, cystic neoplasm, diagnosis, diagnostic value, endometrium, endometrium biopsy, female, fibroma, frozen section, histopathology, human, human tissue, immunohistochemistry, leiomyoma, mitosis rate, MRI scanner, myometrium, nuclear magnetic resonance imaging, overtreatment, Papanicolaou test, pelvic pain, smooth muscle tumor, stroma, surgery, surgical technique, uterus, uterus bleeding, uterus myoma
Abstract
Introduction/Objective: Uterine leiomyomas are the most common benign tumors in women of reproductive age, typically presenting with abnormal uterine bleeding, pelvic pain, or a palpable mass. Degenerative changes-including hyaline, red, myxoid, and cystic-can alter their typical appearance. Cystic hydropic degeneration, a rare form, with only about 24 reported cases, may cause a mass to mimic a cystic neoplasm radiologically and grossly, leading to diagnostic uncertainty during surgery. Preoperative imaging and intraoperative gross assessment may suggest malignancy, necessitating frozen section consultation. This case highlights a cystic hydropic leiomyoma in a young woman, illustrating the diagnostic value of integrated pathology, including frozen section analysis and immunohistochemistry. Methods/Case Report: Clinical History: A 26-year-old woman presented with abnormal uterine bleeding and underwent imaging, which revealed a 6.0 x 7.3 x 7.0 cm uterine mass concerning for a degenerating fibroid. Preoperative Workup: Pap smear: Negative for intraepithelial lesion or malignancy (02/18/2025) Endometrial biopsy: Benign proliferative endometrium (04/10/2025) MRI: Moderately enlarged uterus with fundal mass, presumed degenerating fibroid (03/16/2025) Surgical Procedure: Abdominal myomectomy was performed. Gross Examination: A 214 g, 12 x 10 x 5.5 cm tan-white mass with multiloculated cystic spaces filled with serosanguineous fluid. Frozen Section Diagnosis: Benign fibroid with cystic change; no malignancy identified. Microscopic Findings: Multiloculated cystic spaces lacking epithelial or mesothelial lining, surrounded by smooth muscle. No cytologic atypia, mitotic activity, or necrosis identified. Immunohistochemistry: Desmin and SMA: Positive (smooth muscle) CD10, Calretinin, CK AE1/AE3: Negative (rules out stromal, mesothelial, and epithelial lesions) Final Diagnosis: Leiomyoma with extensive cystic hydropic degeneration. Results: NA Conclusion: Cystic hydropic leiomyomas are benign uterine smooth muscle tumors that can mimic cystic or malignant neoplasms both radiologically and intraoperatively. Accurate diagnosis relies on a combination of frozen section, histopathologic evaluation, and confirmatory immunohistochemistry. Awareness of this entity prevents overtreatment and inappropriate surgical management.
Volume
164
First Page
S79
