CHAPTER 15

Surgical Treatment of Unusual Myoma Conditions

Several bizarre variants of myoma may be encountered. Benign metastasizing myoma (leiomyomatosis peritonealis disseminata) consists of multiple intraperitoneal benign tumors and even distant myoma metastasis, typically to the lungs (Fig. 15–1). These cases may have a propensity for occurrence during pregnancy. Symptoms include paroxysmal attacks of dyspnea and hemoptysis. Myomas may regress after the pregnancy terminates (see Fig. 15–1).

Intravenous leiomyomatosis is associated with smooth muscle tumors extending into venous channels (Fig. 15–2). This condition illustrates clinically the enigma about the origins of uterine leiomyomata in general: Do these tumors arise from a smooth muscle cell from the myometrium or from a smooth muscle cell within the media of the blood vessel itself? This unusual phenomenon represents a dissociation between clinical and histologic malignancy in which benign uterine myomas may propagate via blood vascular channels, although the condition rarely kills the patient.

The uterus is typical of one containing irregularly enlarged myomata uteri (Fig. 15–3

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