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Ovarian inflammatory myofibroblastic tumour fistulating on to the anterior abdominal wall

Leiomyoma is a rare ovarian tumour. There is little known about the natural history of these presumably benign tumours. Reported cases in the literature highlight its benign course, which is similar to uterine leiomyoma. However, they do cause diagnostic difficulty as an adnexal mass in women of all ages but especially in postmenopausal women. This was the case in our patient who presented with a persistent adnexal mass in the postmenopausal period with normal CA125. As our patient remained asymptomatic gynaecologically and there was no noticeable change in the size or appearance of the adnexal mass and also in the absence of personal or family history of gynaecological or bowel malignancy, it was considered reasonable at the time not to undertake other tumour markers in the presence of normal CA125. The patient ultimately underwent a laparoscopic bilateral salpingo-oophorectomy. Histology revealed a right unilateral ovarian leiomyoma. Approximately 60 cases of ovarian leiomyomas have been reported in the literature (to 2007). Ovarian leiomyomas have been reported in all age groups including adolescents (Wei et al. 2008) and postmenopausal women in their 70s (Kawano et al. 2006). Ovarian leiomyomas are almost always diagnosed retrospectively on histological examination only. Clinically, they usually present as a small unilateral pelvic mass which is indistinguishable from subserous leiomyomas and ovarian fibromas (Güney et al. 2007), hence posing a significant diagnostic challenge. Ultrasound imaging is non-specific in making a diagnosis but the appearance on magnetic resonance imaging (MRI) is reported to be similar to that of uterine leiomyoma (Tamada et al. 2006), suggesting its potential usefulness for the diagnosis of ovarian leiomyoma. Similar to uterine leiomyomas, although the prognosis is presumed to be good, the short follow-up period of the series studied in the literature (Doss et al. 1999) precludes definitive evaluation of their natural history. This case report demonstrates the occurrence of this rare form of benign ovarian tumour that poses diagnostic difficulty for the clinician as well as a cause for significant anxiety for the patient, especially in the postmenopausal age group. Many women with adnexal pathology are asymptomatic and are referred following an incidental finding when the only way to confirm benign disease is to embark on a surgical procedure with the attendant risks.