Abstract

Background: Leiomyoma variants may occasionally recur or metastasize; however, there is limited evidence guiding clinical decision making following this histological diagnosis and recurrence risk is uncertain.Aim: To improve understanding of the incidence, behavior and outcomes of leiomyoma variants to inform clinical practice.Materials and Methods: A retrospective review from 2004–2015 was conducted of all patients who underwent uterine surgery for symptomatic fibroids at a tertiary hospital in Melbourne, Australia. Data regarding leiomyoma variants were analyzed to determine which variants were more likely to recur or metastasize with a note made of cases that underwent morcellation.Results: 1878 operations for symptomatic fibroids were performed, and 111 leiomyoma variants (5.9%) were identified. Most were premenopausal, presenting with heavy menstrual bleeding and/or pressure symptoms. Of the leiomyoma variants, 5 (4.5%) recurred; occurring 1–6 years postoperatively with epithelioid leiomyomas (n=1), intravascular leiomyomatosis (IVL; n=2) and cellular leiomyomas (CL; n=2). One of these cases underwent power morcellation. Three patients had recurrences involving lung lesions. Most patients were discharged at their 6-week postoperative review with the reassurance of a benign diagnosis, with no follow-up advised.Conclusion: Patient counseling and follow-up postdiagnosis of a leiomyoma variant are inconsistent. In line with published recommendations, our findings support long-term clinical surveillance and consideration of annual imaging, following a diagnosis of IVL. Our data suggest this could also be extended to a CL and epithelioid leiomyoma diagnosis, given the small risk of disease recurrence. Confirmation with multicenter studies is required to establish definitive management guidelines.