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Variants of uterine leiomyomas (fibroids)

Elizabeth A Stewart, MD
Bradley J Quade, MD, PhD
Shannon K Laughlin-Tommaso, MD
Section Editors
Robert L Barbieri, MD
Rochelle L Garcia, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Benign uterine leiomyomas (fibroids) are smooth muscle neoplasms of the myometrial layer of the uterus and are the most common pelvic tumor in women [1-3]. Less commonly, women with a uterine mass presumed to be a leiomyoma are found to have a uterine sarcoma or a leiomyoma variant. There are a number of leiomyoma variants in which the smooth muscle neoplasm manifests one histologic facet typical of malignant neoplasm, yet lacks others. Other variants are defined by their capacity to spread to other organs without invasion, and thus remains histologically benign. Finally, some smooth muscle neoplasm variants cannot be definitely classified and consequently are deemed to have an uncertain malignant potential. (See "Differentiating uterine leiomyomas (fibroids) from uterine sarcomas", section on 'Presumed benign leiomyomas'.)

Histologically and biologically defined variants of uterine leiomyomas are reviewed here. The diagnosis and management of ordinary uterine leiomyomas, as well as approaches to differentiating leiomyomas from uterine sarcomas, are discussed separately. (See "Uterine leiomyomas (fibroids): Epidemiology, clinical features, diagnosis, and natural history" and "Overview of treatment of uterine leiomyomas (fibroids)" and "Differentiating uterine leiomyomas (fibroids) from uterine sarcomas".)


Uterine fibroids (leiomyomas) are very common. In contrast, other myometrial smooth muscle variants are less frequent (approximately 1 to 2 percent in aggregate) and uterine sarcomas are rare (0.1 percent or less, depending on age) [4]. Differentiating between these, and thus providing appropriate evaluation and treatment, is clinically challenging.

Most leiomyoma variants present as presumed typical "fibroids" and are excised by gynecologists if they are symptomatic. The presence of an extrauterine mass makes it clear that this is a leiomyoma variant rather than a typical leiomyoma. Some of these cases come to attention as referrals when a woman with a thoracic mass initially presents to pulmonary or cardiovascular colleagues.

The rarity of leiomyoma variants limits epidemiologic study and, by extension, evidence-based guidance for diagnosis and treatment, especially for selected variant types that essentially are restricted to case reports and small case series. Most variants, being histologically defined, are diagnosed only after surgical removal; however, increasingly, abnormal magnetic resonance imaging (MRI) may suggest an atypical lesion, sometimes even prompting surgical excision.

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Literature review current through: Nov 2017. | This topic last updated: Nov 28, 2017.
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