Angioleiomyoma Uterus,Unique Variant of Uterine Leiomyoma

Abstract

Abstract

Uterine leiomyomas or fibroids are benign smooth muscle tumors of the uterus originates from smooth muscle and has thick blood walled vessles. Most women are         asymptomatic while others complain of painful or heavy period and abdominal mass. Uterine angiolieomyoma is one of the extremely rare variant and only15 cases have been reported in the literature up to date. The case described here is about a 48 year old women  who presented with abdominal distension and pain.

Introduction

Uterine angioleiomyoma is an extremely rare and unique variant of leiomyoma otherwise known as vascular leiomyoma originating from smooth muscle cells and         containing thick-walled vessels and usually occurs in         subcutaneous tissue, most often in the lower extremities and very rarely in the uterus.^1,2 They occur middle-aged women and can present as an abdominal mass or with symptoms of abdominal pain and menorrhagia.³ These tumors can undergo spontaneous rupture and cause catastrophic intra-abdominal bleeding. A diagnosis of AL was made on histopathologic examination.

Case report  

A 48 year old postmenopausal woman, came to the   out patient department of gynaecology at SMIMS,               Kulasekharam with complaints of lower abdominal pain for 1 month which was intermittent, dull aching and abdominal   distension. She had attained menopause at the age of 45 years. Her obstetric score was P2l2A1 sterilized with all being full term normal deliveries.

         On  examination, she is moderately built,                      BMI – 27.40 kg/sq.m2, No pallor,lymphadenopathy, and    oedema. Her vitals were stable and systemic examination showed no abnormalities.Per abdomen she was found to have a 22 weeks size uterus, non tender mobility restricted.          On local examination, vulva and vagina shows atrophic changes, but per speculum examination showed a cervix with posterior lip hypertrophy, no discharge.

Per vaginal examination showed a 22 weeks uterus, non tender, firm in consistency, mobile and bilateral for              nix freePost operative period was uneventful. Histopathology report came as a  Angioleiomyoma uterus.On investigations she was found to have a haemoglobin level of 12 g/dl.USG showed a uterus of size (11.5 x 5.3 x 5.2 cm), with hypoechoic mass, lesion arising from posterior myometrium of uterus (15x11cm) is seen extending upto to level of umbilicus. Moderate vasularity seen.     A subserous fibroid (3.5x2.2cm) is seen arising from  posterior myometrium of lower body.Endometrium not separately          visualized.Ovaries not visualised. PAP smear showed negative for intraepithelial lesion.She underwent Total Abdominal         Hysterectomy with bilateral salpingo-oophorectomy 9/3/17.Intraoperatively she was found to have uterus enlarged in size 26-28 weeks variable in consistency, highly vascular,both ovaries&tubes.Post operative period was uneventful. Histopathology report came as a Angioleiomyoma uterus.