Epithelioid Leiomyoma of the Uterus: A Rare Tumor Mimicking Malignancy

The majority of the smooth muscle tumors of the uterine tract are leiomyomas. A thorough histopathological study of these common lesions is mandatory despite a negligent tendency to omit thorough gross examination. Among the various histopathological subtypes of leiomyomas, epithelioid leiomyoma comprises an uncommon variant that does not display the classic spindle cell morphology of a conventional leiomyoma and could be confused histopathologically with smooth muscle tumor of uncertain malignant potential (STUMP), perivascular epithelioid cell tumor (PEComa), leiomyosarcoma, and endometrial stromal sarcomas (ESS). In this case report, we present an interesting case of epithelioid leiomyoma in a 38-year-old female patient with complaints of persistent lower abdominal pain for a year. A contrast-enhanced magnetic resonance imaging of the pelvis revealed a well-defined, heterogeneously enhancing mass lesion with a broad base towards the lateral body of the uterus and the lower uterine segment. The findings were suggestive of a subserosal/broad ligament fibroid (FIGO VII) with signs of degeneration. Intraoperatively, the large subserosal fibroid had distorted the normal anatomy, making it challenging to dissect the cervix. Therefore, a subtotal hysterectomy with bilateral salpingo-oophorectomy was done. Histopathological examination and immunohistochemistry led to the diagnosis of epithelioid leiomyoma.