Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 40874
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size

LETTER TO EDITOR Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 4  |  Page : 592-594
A case of ovarian leiomyoma with cystic degeneration

Department of Pathology, Alluri Seetharamaraju Academy of Medical Sciences, ELURU, W.G.Dt. Andhra Pradesh, India

Click here for correspondence address and email

Date of Web Publication1-Oct-2009

How to cite this article:
Ramalakshmi Pullela V B, Das S, Chunduru B, Dua S. A case of ovarian leiomyoma with cystic degeneration. Indian J Pathol Microbiol 2009;52:592-4

How to cite this URL:
Ramalakshmi Pullela V B, Das S, Chunduru B, Dua S. A case of ovarian leiomyoma with cystic degeneration. Indian J Pathol Microbiol [serial online] 2009 [cited 2023 Sep 23];52:592-4. Available from:


Leiomyoma arising primarily in the ovary is rare and fewer than 55 examples have been reported. [1],[2] The majority of them are very small and are discovered incidentally. We report one huge ovarian leiomyoma in a 53-year-old lady, clinically and radiologically mimicking mucinous cystadenoma.

A 53-year-old postmenopausal female presented with abdominal pain of two years duration, which increased five months prior to the presentation. There was a 16 - 18 weeks sized mass palpable per abdomen was diagnosed as ovarian cyst . Ultrasonography revealed a huge complex ovarian cyst on right ovary.

Per-operatively, right ovary was enlarged, cystic measuring 15 x 20 cm, extending retroperitoneally but was mobile and not attached to retroperitoneal structures. Bilobed ovarian mass with normal uterus and other ovary was excised [Figure 1]. The larger lobe measured 16 x 10 x 5 cm and smaller lobe measured 12 x 8 x 4 cm. Cut section showed multiple cystic areas with mucoid material and grey white solid whorled areas.

Sections examined from different parts of the tumor showed typical appearance of a leiomyoma [Figure 2] with a rim of ovarian stroma. There were large areas of myxomatous cystic degeneration and hyaline change. No cytological pleomorphism or mitotic figures could be found. There was a small interstitial leiomyoma. The other ovary showed diffuse nodular stromal hyperplasia. Tumor cells were strongly positive for desmin and smooth muscle actin [Figure 3].

The age incidence of ovarian leiomyoma varies between 20 and 65 years . [4] Approximately 16% cases occur after menopause. [4] Most tumors are asymptomatic, some present with a palpable abdominal mass, ascitis or hydronephrosis.

Ovarian leiomyoma is usually unilateral, varies in size, with most displaying a diameter < 3 cm. In the present case the tumor was very large, cystic, resembling mucinous cystadenoma. Kim et al., reported one such case where the leiomyoma was multiloculated, multisepted and mainly cystic. [5]

Several theories have been proposed regarding the histogenesis of the tumors. The most readily accepted explanation is that they arise from the smooth muscle of the ovarian ligaments where they enter the ovary or from the smooth muscle of the ovarian blood vessels. [3] Endometriotic cysts are also suggested to trigger metaplasia of surrounding stroma into smooth muscle cells. [2]

The correct diagnosis of ovarian leiomyoma requires recognition of the smooth muscle nature of the tumor. [1],[3] In the present case smooth muscle actin and desmin positivity was observed [Figure 3].

The differential diagnosis includes ovarian fibroma, thecoma, cellular fibroma and sclerosing stromal tumor. [2] Primary ovarian leiomyoma should also be distinguished from tumors arising from the broad ligament and extending into the hilum of ovary or wandering leiomyoma. [3] The tumor in our case was of ovarian origin because at one end of the tumor there was only a thin rim of residual ovarian tissue and the tube was stretched over the tumor. Coexistence of ovarian leiomyoma with uterine leiomyoma has been reported by several authors. [3] These tumors are benign and may be treated by the least radical surgery that is necessary for their complete removal.

   References Top

1.Seidman JD, Russell P, Kurman RJ. Surface epithelial tumors of the ovary. Kurman RJ, editor. Blaustein's pathology of the female genital tract. 5 th ed. New York: Springer-Verlag; 2002. p. 791-904.  Back to cited text no. 1      
2.Erkaya S, Kutlay B, Uygur D, Kra F, Tezer A. Primary ovarian leiomyoma in a postmenopausal woman. Acta Obstet Gynecol scand 2000;79:79-87.  Back to cited text no. 2      
3.Tsalacopoulos G, Tiltman AJ. Leiomyoma of the ovary: A report of 3 cases. S Afr Med J 1991;11:574-6.  Back to cited text no. 3      
4.Fallahzadeh H, Dockerty MB, Lee RA. Leiomyoma of the ovary: Report of 5 cases and review of the literature. Am J Obstet Gynecol 1972;113:394-8.  Back to cited text no. 4      
5.Kim JC, Nam SL, Suh KS. Leiomyoma of ovary mimicking mucinous cystadenoma. Clin Imaging 2000;24:34-7.  Back to cited text no. 5      

Correspondence Address:
V B Ramalakshmi Pullela
Department of Pathology, Asram Medical College, Eluru.W.G.Dt. Andhra Pradesh -534 004
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.56141

Rights and Permissions


  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Primary ovarian leiomyoma: A rare tumor with a diagnostic dilemma
K Sajitha, HL Kishan Prasad, Gaurvi Piplani, Neetha Nandan, Michelle Mathias, JayaprakashK Shetty
International Journal of Clinicopathological Correlation. 2020; 4(1): 17
[Pubmed] | [DOI]
2 Giant Primary Ovarian Leiomyoma A Diagnostic Dilemma
Vishwas Pai
Journal of Anesthesia and Surgery. 2016; 3(4): 1
[Pubmed] | [DOI]
3 A Rare Combination of Ovarian and Uterine Leiomyomas with Goblet Cell Carcinoid of the Appendix
Abdulrahman F. Al-Shaikh,Abdulla Darwish,Veena Nagaraj,Abeer Alsada
Case Reports in Surgery. 2015; 2015: 1
[Pubmed] | [DOI]
4 Large ovarian leiomyoma in a postmenopausal woman
Safaei, A., Khanlari, M., Azarpira, N., Monabati, A.
Indian Journal of Pathology and Microbiology. 2011; 54(2): 413-414
5 Ovarian leiomyoma as a potential cause of compromised fertility
Yu-Jin Koo, Yeon-Jean Cho, Ji-Young Kim, Ji-Eun Lee, Mi-La Kim, Joo-Myung Kim, Ho-Won Han, Kwan-Young Joo
Fertility and Sterility. 2011; 95(3): 1120.e11
[VIEW] | [DOI]
6 Large Cystic Degenerated Leiomyoma: A Case Report and Review of Similar Unusual Presentations and Diagnostic Dilemmas in Gynecology
Christopher A. Enakpene, Kiranmayi V. Mechineni, Christina Pardo, Lisa Rickett-Holcolm, Charles Bowers, Ozgul Muneyyirci-Delale
Journal of Gynecologic Surgery. 2011; 27(4): 299
[VIEW] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  

    Article Figures

 Article Access Statistics
    PDF Downloaded214    
    Comments [Add]    
    Cited by others 6    

Recommend this journal