Calcifying uterine leiomyoma invading the urinary bladder
© Springer-Verlag 2007
Received: 14 January 2007
Accepted: 28 April 2007
Published: 1 June 2007
Leiomyomas are common benign tumors of the female genital tract and can be the leading cause of dysfunctional uterine bleeding, recurrent miscarriage or abdominal discomfort. Degeneration of fibroids occurs in menopause and is associated with fatty, hyaline, cystic, or myxoid degeneration or dystrophic calcification. However, based on their benign nature, these tumors are not known to invade other tissues. We here describe a rare case of an extensively calcified myoma invading the urinary bladder in an elderly patient who presented with hematuria and moderate abdominal discomfort.
Benign neoplasms of the uterine muscle are common entities and can be found in up to 30% of the reproductive female population . Leiomyomas most commonly involve the uterine fundus and corpus but can also be observed in the cervix or round ligaments and are composed of smooth muscle and varying amounts of fibrous connective tissue. Submucous growth and distortion of the endometrial cavity can be associated with dysfunctional uterine bleeding and subfertility due to impaired implantation . On rare occasions, abdominal discomfort or even pelvic pain is caused by gross enlargment of these tumors. Although leiomyomas have been reported to reach sizes of up to 30 cm in diameter  and weights of over 40 kg , these tumors do not usually penetrate surrounding tissues due to their benign nature and encapsulated condition. We here report a case of a calcifying uterine fibroid with bladder invasion associated with hematuria as the primary clinical manifestation of disease.
Various types of degeneration of leiomyomatous tissue have been reported as a consequence of gross enlargement and a relative reduction in sufficient blood supply. These include hyaline, cystic, myxoid or dystrophic calcifications . Whereas hyalinization can be observed in up to 60% of cases, cystic degeneration and calcification are less common and occur in about 5% . Calcification of fibroids usually appears dense and amorphous on plain radiography or may exhibit ring-like structures corresponding to thrombosed veins from previous stages of degeneration undergoing calcification [6, 7].
Although uterine fibroids may greatly enlarge and deviate the position of surrounding organs such as the bladder, their growth pattern is expansive and usually follows rounded borders in contrast to diffuse and infiltrative growth of sarcomatous tissue. The case presented in this report emerges as a rare exception of this rule by exhibiting invasion into the posterior wall of the bladder despite its entirely benign nature. One possible explanation for this rather unusual growth pattern is the presence of multiple stone-like structures representing extensive calcification of leiomyomatous tissue. We suggest that mechanical irritation of mucosal and muscular tissue layers of the bladder was followed by secondary atrophy and erosion of the posterior wall during further enlargement of the fibroid. This was associated with hematuria and urinary frequency. Although uterine leiomyomata have been shown to display a wide spectrum of appearances on radiological imaging studies reflected by either ill-defined borders or varying degrees of echogenity or signal intensity, we here report a case exhibiting infiltrative rather than expansive growth of these benign tumors thereby adding to the diagnostic confusion.
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