128
Letters to the Editor
References 1
2 3
4
Correspondenceto:
Heinonen PK: Clinical implications of the unicomuate uterus with rudimentary horn. Int J Gynecol Obstet 21: 145, 1983. Johansen K: Pregnancy in a rudimentary born. Obstet Gynecol 34: 805, 1969. O’Grady JP, Salem FA: Rudimentary horn pregnancy with neonatal and maternal survival. J Nat1 Med Assoc 70: 863, 1978. O’Leary JL, O’Leary JA: Rudimentary horn pregnancy. Obstet Gynecol 22: 371, 1963.
Tufan Bilgin Uludsg universitesi Tip Fakiiltesi Kadii Hastaliklari ve D6gum Ann Bilim Dali 16069 Bursa, Turkey
Leiomyoma of the fallopian tube: an unusual cause of abdominal pain
To the Editor
January 27th, 1992
Leiomyoma of the fallopian tube is a relatively rare tumor. This case represents the first such reported in the English speaking Caribbean. A 38-year-old woman of East Indian descent (gravida 6, para 5 + 1) presented with a -day history of severe, cramping, lower ab i ominal pain. Her menstrual period had been due 2 weeks prior to presentation but had actually started on the day before she presented. The pain was described as being unlike her usual dysmenorrhoea and had not been relieved by a 75-mg intramuscular injection of diclofenac (Voltaren, Ciba-Geigy, Basle, Switzerland). The past medical history revealed an ectopic pregnancy 17 years earlier and tubal ligation 8 years prior to presentation. The significant clinical finding was that of lower abdominal tenderness. No masses were palpable. The pain progressively worsened and exploratory laparotomy was performed on the third hospital day. A right tubal mass was seen. Total hysterectomy, right salpingectomy and appendectomy were performed in accordance with the patient’s preoperative wishes. Pathological examination revealed a gross-
KeywordszLeiomyoma; Fallopian tube; Abdominal pain. Int J Gynecol Obstet 38
ly and histologically unremarkable uterus. A smooth, encapsulated, 2-cm diameter mass arose from the cornual end of the fallopian tube compressing the lumen to a slit. Histology of the mass revealed interlacing whorls of smooth muscle fibers typical of a leiomyoma. No ischemic changes were present. The vermiform appendix was unremarkable. Leiomyomas of the fallopian tube are as uncommon as those of the corpus uteri are myriad [I]. The difference in incidence is ascribed to a combination of two factors the abundance of smooth muscle in the corpus and the marked cyclical changes induced in the corpus (including the myometrium) by ovarian hormones, in comparison to the relative nonreactivity of the tubal musculature, even during pregnancy [2]. The fact that this case represents the first such reported in Jamaica, a country with a predominantly black population, underscores the relative rarity of this tumor especially when one considers that leiomyomas of the uterus are more common in black women than in white [3]. Tubal leiomyomas are usually asymptomatic [4]. Those that present clinically are usually large and present either as an adnexal mass or with an acute abdomen consequent on.torsion [2]. Our tumor was unusual in that while small, it presented with acute abdominal pain. The mechanism by which the pain developed might be related to tubal colic secondary to
Letters to the Editor
luminal obstruction by compression from the intramural tumor. It is important to note that the pain did not recur postsurgery. C.T. Eaeoffery H. Fletcher
Department of Pathology Department of Obstetrics and Gynecology University of the West Indies Mona, Jamaica, West Indies
References 1 Roberts CL, Marshall HK: Fibromyoma of the fallopian tube. Am J Obstet Gynecol82: 364, 1961. 2 Honore LH, Dunnett IP: Leiomyoma of the fallopian
3
4
129
tube. A case report and review of the literature. Arch Gynekol221: 47, 1976. Zaloudek C, Norris HJ: Mesenchymal tumours of the uterus. In: Blaustein’s Pathology of the Female Genital Tract, 3rd edition (ed RJ Kurman) p 374. SpringerVerlag, New York, 1987. Woodruff JD, Pauerstein CJ: The Fallopian Tube, p 247. Williams and Wilkins, Baltimore, 1969.
co
to:
C.T. Eseoffery Departmem of P8tboIngy
university of the west Indies Mona, Jam&a,
West IndIes
Int J Gynecol Obstet 38
Letters to the Editor
References 1
2 3
4
Correspondenceto:
Heinonen PK: Clinical implications of the unicomuate uterus with rudimentary horn. Int J Gynecol Obstet 21: 145, 1983. Johansen K: Pregnancy in a rudimentary born. Obstet Gynecol 34: 805, 1969. O’Grady JP, Salem FA: Rudimentary horn pregnancy with neonatal and maternal survival. J Nat1 Med Assoc 70: 863, 1978. O’Leary JL, O’Leary JA: Rudimentary horn pregnancy. Obstet Gynecol 22: 371, 1963.
Tufan Bilgin Uludsg universitesi Tip Fakiiltesi Kadii Hastaliklari ve D6gum Ann Bilim Dali 16069 Bursa, Turkey
Leiomyoma of the fallopian tube: an unusual cause of abdominal pain
To the Editor
January 27th, 1992
Leiomyoma of the fallopian tube is a relatively rare tumor. This case represents the first such reported in the English speaking Caribbean. A 38-year-old woman of East Indian descent (gravida 6, para 5 + 1) presented with a -day history of severe, cramping, lower ab i ominal pain. Her menstrual period had been due 2 weeks prior to presentation but had actually started on the day before she presented. The pain was described as being unlike her usual dysmenorrhoea and had not been relieved by a 75-mg intramuscular injection of diclofenac (Voltaren, Ciba-Geigy, Basle, Switzerland). The past medical history revealed an ectopic pregnancy 17 years earlier and tubal ligation 8 years prior to presentation. The significant clinical finding was that of lower abdominal tenderness. No masses were palpable. The pain progressively worsened and exploratory laparotomy was performed on the third hospital day. A right tubal mass was seen. Total hysterectomy, right salpingectomy and appendectomy were performed in accordance with the patient’s preoperative wishes. Pathological examination revealed a gross-
KeywordszLeiomyoma; Fallopian tube; Abdominal pain. Int J Gynecol Obstet 38
ly and histologically unremarkable uterus. A smooth, encapsulated, 2-cm diameter mass arose from the cornual end of the fallopian tube compressing the lumen to a slit. Histology of the mass revealed interlacing whorls of smooth muscle fibers typical of a leiomyoma. No ischemic changes were present. The vermiform appendix was unremarkable. Leiomyomas of the fallopian tube are as uncommon as those of the corpus uteri are myriad [I]. The difference in incidence is ascribed to a combination of two factors the abundance of smooth muscle in the corpus and the marked cyclical changes induced in the corpus (including the myometrium) by ovarian hormones, in comparison to the relative nonreactivity of the tubal musculature, even during pregnancy [2]. The fact that this case represents the first such reported in Jamaica, a country with a predominantly black population, underscores the relative rarity of this tumor especially when one considers that leiomyomas of the uterus are more common in black women than in white [3]. Tubal leiomyomas are usually asymptomatic [4]. Those that present clinically are usually large and present either as an adnexal mass or with an acute abdomen consequent on.torsion [2]. Our tumor was unusual in that while small, it presented with acute abdominal pain. The mechanism by which the pain developed might be related to tubal colic secondary to
Letters to the Editor
luminal obstruction by compression from the intramural tumor. It is important to note that the pain did not recur postsurgery. C.T. Eaeoffery H. Fletcher
Department of Pathology Department of Obstetrics and Gynecology University of the West Indies Mona, Jamaica, West Indies
References 1 Roberts CL, Marshall HK: Fibromyoma of the fallopian tube. Am J Obstet Gynecol82: 364, 1961. 2 Honore LH, Dunnett IP: Leiomyoma of the fallopian
3
4
129
tube. A case report and review of the literature. Arch Gynekol221: 47, 1976. Zaloudek C, Norris HJ: Mesenchymal tumours of the uterus. In: Blaustein’s Pathology of the Female Genital Tract, 3rd edition (ed RJ Kurman) p 374. SpringerVerlag, New York, 1987. Woodruff JD, Pauerstein CJ: The Fallopian Tube, p 247. Williams and Wilkins, Baltimore, 1969.
co
to:
C.T. Eseoffery Departmem of P8tboIngy
university of the west Indies Mona, Jam&a,
West IndIes
Int J Gynecol Obstet 38
