Sami Ghazaleh, MD1, Christian Nehme, MD1, Azizullah Beran, MD1, Mohammed T. Awad, MD1, Dipen Patel, MD, MBA1, Sachit Sharma, MD1, Taha Sheikh, MD1, Muhannad Heif, MD2; 1University of Toledo Medical Center, Toledo, OH; 2ProMedica Toledo Hospital, Sylvania, OH
Introduction: Leiomyomas are benign tumors that originate from smooth muscles. The most common location is the uterus where they are referred to as uterine fibroids. We report a rare case of rectal leiomyoma that was identified during a screening colonoscopy.
Methods: A 54-year-old female patient was referred to the gastroenterology clinic by her primary care physician for a screening colonoscopy. She had never had a colonoscopy and was asymptomatic at the time of evaluation. Past medical history was significant for essential hypertension, gastroesophageal reflux disease (GERD), depression, and morbid obesity. Past surgical history was significant for appendectomy at the age of 11. Home medications included losartan 50 mg daily and metoprolol tartrate 25 mg twice daily. Family history was negative for gastrointestinal (GI) disorders. She drank alcohol socially and had never smoked or used illicit drugs. Screening colonoscopy revealed 2 semi-pedunculated polyps in the sigmoid colon and 5 sessile polyps in the transverse colon. The polyps were 5 to 12 mm in size. The polyps were removed with a hot snare and retrieved successfully without complications. Biopsies of the polyps were consistent with tubular adenomas and hyperplastic polyps. Digital rectal exam revealed a 2 cm smooth rectal mass palpated 4 to 5 cm from the anal verge. Computed tomography (CT) of the abdomen and pelvis was done to evaluate the rectal mass. It revealed a 4.6 cm soft tissue mass right to the rectum. Magnetic resonance imaging (MRI) showed a 3.5 x 3.8 x 5.2 cm smooth well-circumscribed mass external to the levator ani adjacent to the right rectum and right vagina with central necrosis. This was followed by endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) biopsy, which showed normal muscle tissue consistent with leiomyoma. The patient is currently scheduled to undergo surgical resection of the rectal mass. Discussion: Rectal leiomyomas are rare entities that can present with intestinal obstruction, bleeding, or perforation. They can also be asymptomatic and discovered incidentally by imaging or endoscopy. Although they can be diagnosed with EUS-guided FNA, surgical resection is required to differentiate this benign condition from the malignant leiomyosarcoma.
MRI of the pelvis showing the rectal mass
Colonoscopy showing the rectal mass
Endoscopic ultrasound (EUS) showing the rectal mass
Disclosures: Sami Ghazaleh indicated no relevant financial relationships. Christian Nehme indicated no relevant financial relationships. Azizullah Beran indicated no relevant financial relationships. Mohammed Awad indicated no relevant financial relationships. Dipen Patel indicated no relevant financial relationships. Sachit Sharma indicated no relevant financial relationships. Taha Sheikh indicated no relevant financial relationships. Muhannad Heif indicated no relevant financial relationships.