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SonoPhile

A 49-year-old woman, gravida 1 para 1, accidentally presented with an egg-sized abdominal mass. Symptoms of fever, abdominal pain, and weight loss were not present, and she had previously undergone myomectomy. Physical examination revealed a rigid mass, with moderate motion and no tenderness.

Multiple benign metastasizing leiomyoma in the abdominal wall

  • Symptoms: Accidental finding of egg-sized abdominal mass, no fever, abdominal pain, or weight loss

  • Medical History: Previous myomectomy

  • Physical Examination: Rigid mass, moderate motion, no tenderness

  • Ultrasound Examination:

    • Multiple hypoechoic masses in the subcutaneous fascia layer

    • Largest masses: 41 x 25mm and 20 x 16mm with clear boundaries, connected

    • Color Doppler Flow Imaging (CDFI): Punctate blood flow signal, resistance index 0.74

    • Contrast-Enhanced Ultrasound (CEUS):

      • Larger mass: High enhancement in arterial and venous phases

      • Smaller mass: No enhancement in arterial phase, low enhancement in venous phase

  • MRI:

    • Circular abnormal signal shadows on anterior abdominal wall and abdominal cavity (29 x 16mm and 31 x 21mm)

    • Slightly longer T1 and T2, limited diffusion, progressive enhancement

  • CT Scan: No abnormalities

  • Tumor Markers: CEA, AFP, CA724, CA199, and CA125 all normal

  • Biopsy: Suggested spindle cell tumor, likely fibromatosis due to surgical history

  • Surgical Findings:

    • Elective resection of abdominal wall and abdominal cavity tumors

    • Two masses: 4 x 3cm and 2 x 2cm

    • Larger mass protruding into abdominal cavity, smaller mass in anterior sheath of rectus muscle

    • Complete removal of masses, 2/3 of rectus abdominis muscle, and part of posterior sheath

    • Tension-free repair of abdominal wall hernia with patch insertion and suturing

  • Histopathological Examination:

    • Spindle cells

    • Immunohistochemical staining: Positive for smooth muscle actin (SMA), desmin, estrogen receptor (ER), and progesterone receptor (PR)

    • Cell proliferation antigen Ki-67 less than 1%

  • Diagnosis: Benign Metastasizing Leiomyoma (BML)

Conclusion

  • Challenges with BML:

    • Low specificity and incidence rate

    • Potential for misdiagnosis as a malignant tumor

  • Importance of Patient History:

    • Asking about history of myomectomy or hysterectomy can aid in diagnosing BML

  • Role of Pathology:

    • Essential for determining follow-up treatment

  • Biopsy Method:

    • Ultrasound-guided tissue core needle biopsy

    • Effective and safe

    • Recommended diagnostic method

Credit to: Hu, J., Tian, S., Pan, Q., & Yu, Y. (2024). Multiple benign metastasizing leiomyoma in the abdominal wall: a case report and literature review. Frontiers in oncology, 14, 1391850. https://doi.org/10.3389/fonc.2024.1391850

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