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Fallopian tube leiomyoma: a rare clinical entity.

CASE REPORT: A 41-year Para 3 was admitted with colicky pain abdomen with vomiting and features of dehydration. Her cycles were 5-7 days /30 days with excessive flow accompanied with pain and dyspareunia since 7 months. Her L. M. P. was 7 days prior to admission. She was treated with antibiotics for PID in peripheral institutions during this period. All her deliveries were normal with uneventful post-partum period and she underwent minilap tubal ligation 11 years back. Her vitals were stable, abdominal examination revealed a tender distended lower abdomen. On pelvic examination a tender ill-defined mass attached to uterus with restricted mobility was felt in the left adnexa.

USG reported Left adnexal mass simulating Left Ovarian Cyst (Fig. 1).The uterus was normal in size with thin endometrium and the endometrial cavity was empty.

[FIGURE 1 OMITTED]

The blood picture reveled Hb count 11 gram/dl, TLC 10, 200/cmm, (3-hcg 6 ng/ml, other tumour markers (CA 125, CEA, AFP, LDH) within normal limits.

With provisional diagnosis of Twisted Ovarian tumour (left) or degenerated subserous fibroid, we proceeded with the case. After counseling the family members for laparoscopy vs laparotomy, under G. A. laparoscopy was performed, which showed a mass in the left fallopian tube at the isthmic portion undergone torsion. The uterus, right tube and ovary were normal. After untwisting the mass LAVH with BSO was performed. The specimen clearly showed a left fallopian tube leiomyoma (Fig 2). Post- operative period was uneventful.

[FIGURE 2 OMITTED]

The histopathology report came out to be LEFT FALLOPIAN TUBE ADENOLEIOMYOMA at its isthmic portion without any features of malignancy.

Discussion and review of Literature: Leiomyomas of fallopian tube are rare, typically co- incidental findings at autopsy or unrelated surgical procedures. [1] They are mostly single, small and unilateral but may be of variable size from microscopic to more than 15 cm large. [2] They may grow excessively and undergo torsion or degenerations. [3] They are rarely diagnosed pre-operatively. Powerful USG could be helpful in diagnosing this condition, but laparoscopy can be used for definite diagnosis and managements Neither CT nor laparoscopy sometimes could specify the tumour where final diagnosis is made by biopsy. [5] In 2004 for the first time a case could be successfully managed by laparoscopy. [6]

CONCLUSION: Asymptomatic fallopian tube leiomyoma being chance-findings are very rare and symptomatic fallopian tube leiomyoma as in this case are still rarer. This condition should be kept in mind as a differential diagnosis of any adnexal mass.

DOI: 10.14260/jemds/2014/3933

REFERENCES:

[1.] Misao R, Niwa K, Iwagaki S, Shimokawa K, Tamaya T. Gynecol obstet invest 2000; 49 (4) 27980.

[2.] yang CC, wen KC, chen P, Wang PH, primary leiomyoma of the fallopian tube; pre-operative ultrasound findings. J chin med Assoc 2007; 70: 80-83.

[3.] Tarek Bardawil, MD, MBA; Chief Editor: Richard Scott Lucidi, MD, FACOG. http://emedicine.medscape.com/article/275463-overview#showall

[4.] Yang CC, Wen KC, Chen P, Wang PH. J Chin Med Assoc. 2007 Feb; 70 (2): 80-3.

[5.] Journal De Gynecologie Obstetrique Et Biologie De La Reproduction, Volume 37, Issue 8, December 2008, page 799-801.

[6.] Wen Kc, Yang CC, Wang Ph. priamry fallopian tube leiomyoma managed by laparoscopy. J minim invasive gynecol 2005; 12: 193.

Punyabrata Mohapatra (1), Sahadev Sahoo (2), Rabindra Nath Behera (3)

AUTHORS:

(1.) Punyabrata Mohapatra

(2.) SahadevSahoo

(3.) Rabindra Nath Behera

PARTICULARS OF CONTRIBUTORS:

(1.) P. G. Student, Department of Obstetrics and Gynaecology, Hi-Tech Medical College, Bhubaneswar, Odisha.

(2.) Assistant Professor, Department of Obstetrics and Gynaecology, Hi-Tech Medical College, Bhubaneswar, Odisha.

(3.) Professor, Department of Obstetrics and Gynaecology, Hi-Tech Medical College, Bhubaneswar, Odisha.

NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:

Dr. Sahadev Sahoo, Assistant Professor, Department Of Obstetrics And Gynaecology, Hi-Tech Medical College, Bhubaneswar-751025, Odisha. Email: Drssahoo@Outlook.Com

Date Of Submission: 20/11/2014.

Date Of Peer Review: 21/11/2014.

Date Of Acceptance: 27/11/2014.

Date Of Publishing: 01/12/2014.
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Title Annotation:CASE REPORT
Author:Mohapatra, Punyabrata; Sahoo, Sahadev; Behera, Rabindra Nath
Publication:Journal of Evolution of Medical and Dental Sciences
Date:Dec 1, 2014
Words:655
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