Epidemiology, Presentation, and Management of Retroperitoneal Leiomyomata: Systematic Literature Review and Case Report

We report a case of retroperitoneal leiomyoma and a systematic review of the literature regarding this finding. A 45-year-old woman with menorrhagia and a complex pelvic mass underwent preoperative imaging and consequent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathology revealed a 13-cm retroperitoneal, pedunculated leiomyoma arising from the uterus anterior to the internal cervical os. Literature review identified 105 cases of retroperitoneal leiomyomata from 1941 through 2007, with 37 cases, including our own, containing sufficient information for analysis. Abstracted variables included patient age, race, obstetric and gynecologic history, presentation and duration of symptoms, investigations, management, surgical findings, pathologic and immunohistochemical characteristics, duration of follow-up, evidence of recurrence and its management. Mean age (±SD) of the population was 46.27 ± 13.19 years. More than 40% of patients had either undergone hysterectomy for uterine leiomyomata previously or had concurrent uterine leiomyomata. Of patients, 25% were asymptomatic, 31.3% experienced abdominal fullness, 18.8% had urinary symptoms, 18.8% had weight loss, and 18.8% had pelvic pain. Diagnostic evaluation was inconclusive and surgical excision was undertaken in all but 1 case. Median leiomyoma size was 12.0 cm (range 2.0–37.0 cm) with most in the posterior retroperitoneum, independent of the uterus. Pathologic and immunohistochemical investigations were comparable with those of uterine leiomyomata. Surgery was mostly curative with 5 reported cases of recurrence, 3 of which were then considered sarcomatous. Retroperitoneal leiomyomata present diagnostic and therapeutic challenges, and as such require heightened surveillance.