Leiomioma cotiledonoide disecante del útero. A propósito de dos casos y revisión de la literatura Cotyledonoid dissecting leiomyoma of the uterus. Report of two cases and review of the literature

SUMMARY Introduction: Cotyledonoid dissecting leiomyoma or Sternberg tumor is a benign smooth muscle tumor with an unusual growth pattern. Patients and methods: Histopa- thological findings of two cases (41 and 56 year old fema- les) of this rare variant of uterine leiomyoma are analyzed. Results: In both cases several nodules conforming an ute- rus-depending great mass occupying the pelvis were found. Total hysterectomy, bilateral salpingo-oophorectomy and pelvic masses removal were performed. On microscopic examination, several bulbous masses with alarming appea- rance were found. Masses were formed by bundles of smo- oth muscle cells extending over the external uterine surface and continuing with an intramyometrial tumoral component dissecting the uterine wall. Significant nuclear atypia, mito- ses and necrosis were absent. Conclusions: In spite of the alarming aspect of these lesions, their evolution is benign in most cases. The importance of delivering a precise patholo- gical diagnosis will prevent an inadequate treatment of the patients. An intraoperative pathological examination is recommended. RESUMEN Introduccion: El leiomioma cotiledonoide disecante del utero o tumor de Sternberg es un tumor benigno de mus- culo liso caracterizado por tener un patron de crecimiento inusual. Pacientes y metodos: Presentamos los hallazgos histopatologicos de dos casos (pacientes de 41 y 56 anos) de esta rara variante de leiomioma uterino. Inmunohistoquimi- camente se confirmo la naturaleza muscular lisa de las lesiones. Resultados: En ambas pacientes se observo una gran masa polilobulada dependiente del utero que ocupaba la pelvis. Se realizo histerectomia y doble anexectomia con exeresis de masas pelvicas. En el estudio anatomopatologi- co se observaron multiples masas bulbosas de aspecto alar- mante compuestas por haces de musculo liso que se exten- dian por la superficie externa del utero y se continuaban con un componente intramiometrial que disecaba la pared uteri- na. No se encontraron atipia nuclear significativa, mitosis ni necrosis. Conclusiones: A pesar de su aspecto alarmante estos tumores, su comportamiento es benigno, por lo que hacemos hincapie en la importancia de su adecuado diag- nostico. Es muy aconsejable la realizacion de un estudio microscopico intraoperatorio para realizar un adecuado tra- tamiento de las pacientes.