Caspian Journal of Reproductive Medicine
Volume:10 Issue: 1, Winter-Spring 2024

Leiomyomas, benign smooth muscle tumors of the uterus, commonly present with bleeding and are known for their varied morphology. This case report highlights a rare variant, Cotyledonoid dissecting leiomyoma, which poses diagnostic challenges due to its unusual appearance and growth pattern, often mimicking malignancy
We present the case of a 65-year-old female with clinical symptoms of pain, urinary retention, and bleeding, who underwent total abdominal hysterectomy. Gross examination revealed a large mass with lobulated patterns, raising concerns for malignancy. Microscopic examination, however, revealed characteristic features of Cotyledonoid dissecting leiomyoma, including nodular growth and dissection within the myometrium without atypical or mitosis.
 Our literature review identified only 28 reported cases of this variant, emphasizing its rarity and diagnostic importance. Clinicians and pathologists must be aware of this entity to avoid unnecessary overtreatment.
Frozen sections may aid in accurate diagnosis, particularly to preserve fertility in young women. While leiomyomas are predominantly conventional, rare subtypes like Cotyledonoid dissecting leiomyoma warrant recognition to prevent misdiagnosis and ensure appropriate management. This case underscores the importance of histopathological evaluation in guiding clinical decisions for patients with unusual uterine tumors.

Abnormal uterine bleeding (AUB) is a common gynecological challenge, stemming from various endometrial pathologies. This study aims to assess their prevalence, age distribution, symptomatology correlation, and compare sampling techniques.
This prospective cross-sectional study was conducted at a single teaching institute, involving 150 female participants aged between 18 and 70 years who presented with AUB. Endometrial samples were collected using one of three OPD Pipelle brush, surgical dilatation and curettage (D&C), or hysteroscopy.
The study found 41-50-year-olds most affected by AUB (40%), with 64% having given birth three or more times. Proliferative and secretory changes were common (35.3% and 16% respectively). Endometrial hyperplasia without atypia occurred in 12% and with atypia in 4.7%. Endometrial carcinoma was in 3.3% and polyps in 5.3% of cases. Heavy menstrual bleeding with normal duration affected 64%. Technical challenges included sampling failure in 2 pipelle biopsies and 7 D&C cases. Inadequate samples were obtained in 2 pipelle biopsy and 5 D&C cases. Uterine perforation occurred once, managed conservatively.
Our study underscores the burden of endometrial pathologies in AUB patients with predominant proliferative and secretory changes. Sampling challenges, particularly with pipelle biopsy and D&C, emphasize the need for refining methods and exploring alternatives like transvaginal sonography and hysteroscopy to enhance diagnostic accuracy and patient outcomes in AUB management.