A Rare Case Of Symplastic Leiomyoma Of Uterus : A case Report

Year : 2024 | Volume :01 | Issue : 02 | Page : 26-31

    Murad Ahmad

  1. Fatima Qaiser Naqvi

  2. Surabhi Gautam

  3. Veena Maheshwari

  1. Assistant Professor, Department of Pathology, JNMCH, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
  2. Junior Resident, JNMCH, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
  3. Senior Resident, JNMCH, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
  4. Professor, JNMCH, Aligarh Muslim University, Aligarh, Uttar Pradesh, India


Uterine smooth muscle tumors (USMT) are of mesenchymal origin and develop from the smooth muscle cells of the uterus. Leiomyomas and their subtypes are the most commonly occurring USMT’s. Symplastic Leiomyoma is an unusual histologic subtype of Benign Leiomyoma, hence also known as atypical or Bizarre leiomyoma. It is often difficult to differentiate it from Leiomyosarcoma because of its bizarre looking nuclei on histology. However it’s malignant transformation is rare.
Among benign uterine smooth muscle tumors (USMT), symplastic leiomyoma is a unique histologic subtype that is categorized as an unusual or weird leiomyoma. These tumors start in the uterine smooth muscle cells and develop from mesenchymal tissues. Symplastic Leiomyoma is unique among USMTs, leiomyomas, and their subgroups because of its unusual and fascinating histological characteristics. Symplastic leiomyoma and its malignant cousin, leiomyosarcoma, are frequently difficult to distinguish from one another due to the unusual appearance of the tumor’s nucleus upon histological inspection.
Symplastic Leiomyoma is characterized by strange-looking nuclei, which may cause diagnostic ambiguity because these morphological characteristics may resemble those of malignancies. Because of the nuclei’s unusual characteristics, it may be difficult to differentiate them from more severe lesions, which could result in a mistaken diagnosis and cause patients needless anxiety. It is important to stress that, despite the histological similarities, malignant changes in Symplastic Leiomyoma are rare and the tumor usually progresses benignly.
Despite the low overall frequency of malignant development in symplastic leiomyoma, proper therapeutic care depends on a precise diagnosis and categorization. In order to ensure that patients with this benign subtype receive the necessary treatment while avoiding needless interventions typically reserved for malignant conditions, pathologists and clinicians can make more informed decisions regarding patient care with the aid of enhanced understanding of the unique histological features and immunohistochemical markers associated with Symplastic Leiomyoma. When it comes to uterine smooth muscle tumors, this thorough understanding is crucial for improving patient outcomes and improving diagnostic strategies.

Keywords: Symplastic Leiomyoma, Bizarre Nuclei, Uterine Leiomyomas, Ki-67

[This article belongs to International Journal of Toxins and Toxics(ijtt)]

How to cite this article: Murad Ahmad, Fatima Qaiser Naqvi, Surabhi Gautam, Veena Maheshwari A Rare Case Of Symplastic Leiomyoma Of Uterus : A case Report ijtt 2024; 01:26-31
How to cite this URL: Murad Ahmad, Fatima Qaiser Naqvi, Surabhi Gautam, Veena Maheshwari A Rare Case Of Symplastic Leiomyoma Of Uterus : A case Report ijtt 2024 {cited 2024 Mar 02};01:26-31. Available from: https://journals.stmjournals.com/ijtt/article=2024/view=134046

Browse Figures


  1. Ernest A, Mwakalebela A, Mpondo BC. Uterine leiomyoma in a 19-year-old girl: Case report and literature review. Malawi Med J. 2016; 28(1): 31-3.
  2. Gregová M, Hojný J, Němejcová K, Bártů M, et al. Leiomyoma with Bizarre Nuclei: a Study of 108 Cases Focusing on Clinicopathological Features, Morphology, and Fumarate Hydratase Alterations. Pathol Oncol Res. 2020; 26(3): 1527-37.
  3. Kefeli M, Caliskan S, Kurtoglu E, Yildiz L, et al. Leiomyoma With Bizarre Nuclei: Clinical and Pathologic Features of 30 Patients. Int J Gynecol Pathol. 2018; 37(4): 379-87.
  4. Celik M. Leiomyoma with Bizarre Nuclei (Symplastic Leiomyoma) in the Paratubal Cyst Wall: Report of a Rare Case. Int J Surg Pathol. 2021; 29(7): 780-2.
  5. Mamalingam M, Goldberg LJ. Atypical pilar leiomyoma: cutaneous counterpart of uterine symplastic leiomyoma?. Am J Dermatopathol. 2001; 23(4): 299-303
  6. Cree LA. WHO Classification of Tumours: Female Genital Tumours. Edited by WHO Classification of Tumours Editorial Board. IARC. 2020: 272-276.
  7. Cooney EJ, Borowsky M, Flynn C. Case report: Atypical, ‘symplastic’ leiomyoma recurring as leiomyosarcoma in the vagina. Gynecol Oncol Rep. 2015; 14: 4-5.
  8. Su Z, Li G, Wang Y, Yu Z, et al. Bizarre leiomyoma of the scrotum: A case report and review of the literature. Oncol Lett. 2014; 7(5): 1701-3.
  9. Biankin SA, O’Toole VE, Fung C, et al. Bizarre leiomyoma of the vagina: report of a case. Int J Gynecol Pathol. 2000; 19(2): 186-7.
  10. Bell SW, Kempson RL, Hendrickson MR. Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol. 1994; 18(6): 535-58.
  11. Patil N, Mane A, Upadhyay P et.al. Symplastic leiomyoma of uterus – a rare case with review of literature. Int J Health Sci Res. 2022; 12(3): 250-2
  12. Perrone T, Dehner LP. Prognostically favorable “mitotically active” smooth muscle tumors of the uterus. A clinicopathologic study of 10 cases. Am J Surg Pathol. 1988; 12(1): 1-8
  13. Lakshmibai BM, Basavaraj HT, Narasimhamurthy V, Dayananda SB. Atypical (Symplastic) Leiomyoma – A case report. IAIM. 2015; 2(8): 105-8.
  14. Rammesh-Rommani S, Mokni M, Stita W, Traibesi A, Hammisa S, Sriha B, et al. Uterine smooth muscle tumors: retrospective epidemiological and pathological study of 2760 cases. J Gynecol Obstet Biol Reprod (Paris). 2005; 34(6): 568-71.

Regular Issue Subscription Case Study
Volume 01
Issue 02
Received February 15, 2024
Accepted February 17, 2024
Published March 2, 2024