Schwannoma-like uterine leiomyoma with fever of unknown origin and surgical management in a middle-aged woman: A case report

Herein, we describe a 42-year-old woman with multiple uterine leiomyomas with interesting clinical and histologic findings. She had no medical history, except for uterine myomas, which were diagnosed in her early 30s. She presented with fever and lower abdominal pain, and her symptoms did not respond to antibiotics and antipyretics. The clinical evaluation suggested that degeneration of the largest myoma might be the cause of her symptoms, and pyomyoma was suspected. As she had sustained lower abdominal pain, hysterectomy and bilateral salpingectomy were performed. Histopathological examination confirmed the presence of usual-type uterine leiomyomas without suppurative inflammation. The largest tumor showed a rare morphology with a predominant schwannoma-like growth pattern and infarct-type necrosis. Thus, schwannoma-like leiomyoma was diagnosed. This rare tumor might be one of the manifestations of hereditary leiomyomatosis and renal cell cancer syndrome; however, this patient was unlikely to have that rare syndrome. Herein, the clinical, radiological, and pathologic findings of a schwannoma-like leiomyoma are presented and we have raised the question of whether patients with schwannoma-like uterine leiomyoma are more likely to be associated with hereditary leiomyomatosis and renal cell cancer syndrome than those with usual-type uterine leiomyoma.