Surgical management of a large neurilemmoma-like leiomyoma of the uterine cervix mimicking a retroperitoneal tumor

Multiple tumors are derived from the smooth muscle of the uterus and can be classified into pathologies with benign or malignant behavior. Tumor subtypes with unusual histological patterns have also been described, including leiomyomas with schwannoma-like or neurilemmoma-like differentiation. Because these tumors are very rare, preoperative diagnosis is difficult, and their characteristics are often only determined after surgery and histological study (Gisser and Young, 1977). Specifically, these tumors exhibit a regular, spindle-shaped cellular pattern that suggests a peripheral nerve sheath tumor (Gisser and Young, 1977, Kempson and Hendrickson, 2000). Herein, we illustrate a tumor that had not been pre-operatively diagnosed and simulated a retroperitoneal tumor. This tumor required a difficult surgical approach, and subsequent histology demonstrated that it simulated a schwannoma. 1.1. Presentation of case A 46-year-old woman had defined parity and no history of exposure to toxins, chemotherapy, or radiotherapy. She consulted our hospital for abdominal distention, slight vaginal bleeding, hyporexia, quick satiety, and constipation since approximately 6 months. Abdominal ultrasonography revealed a large, solid mass with mixed echogenicity and a cystic component occupying the abdominal and pelvic cavities. The tumor measured more than 30 cm in diameter and displaced the liver and spleen; ascites was not observed. Abdominal computed tomography revealed a large tumor (31.4 cm in diameter) that displaced the intestinal loops toward the anterior and upper region of the abdomen without signs of intestinal obstruction (Fig. 1A). The tumor surrounded and displaced the pelvic body of the uterus toward the abdominal cavity; the myometrium appeared normal, and the endometrium was homogeneous and measured 6 mm. The pelvic cavity and the entire abdomen were occupied by the tumor till the level of the kidney poles (Fig. 1B). No metastatic lesions were evident in the liver, spleen, pancreas, or kidneys. The results on thoracic computed tomography were normal. Colonoscopy revealed extrinsic compression of the left colon, and the esophagogastroduodenoscopy results were normal. The levels of tumor markers were as follows: CA 125, 29 U/ml; CA 19-9, 28 U/ml; and CEA, 2.13 U/ml, all of which were within the normal ranges. Open in a separate window Fig. 1 A. Abdominal computed tomography showing a large heterogeneous abdominal tumor. B. The tumor reaching the level of the kidney poles, causing an ascended uterus and compressing the bladder.