title: Successful pregnancy outcome after laparoscopic-assisted excision of a bizarre leiomyoma: a case report.
abstract: BACKGROUND
  Bizarre leiomyoma is a rare leiomyoma variant that requires a precise histopathological evaluation. Especially when diagnosed in a younger woman, this tumor leads to challenging treatment issues involving fertility preservation. Owing to the low incidence of bizarre leiomyoma, there is insufficient evidence to support myomectomy alone as an appropriate management option. Also, the impact of bizarre leiomyoma on fertility is not well known.
  
  
  METHODS
  A 30-year-old Japanese woman who had never given birth was referred to us because of a uterine tumor with an unusual diagnostic image and was treated by a gasless laparoscopic-assisted excision with a wound retractor. Owing to an unclear margin between her uterine tumor and myometrium, a concomitant excision of adjacent myometrial tissue was required to achieve the maximum resection of her tumor. The histopathological diagnosis was bizarre leiomyoma. Seven months later, she conceived spontaneously and her pregnancy course was uneventful. At 37 weeks of gestation, an elective cesarean section was performed. Although a slight omental adhesion was noted at the postexcisional scar, her uterine wall structure was well preserved and a recurrence of bizarre leiomyoma was not noted.
  
  
  CONCLUSIONS
  A laparoscopic-assisted excision of bizarre leiomyoma is a feasible and minimally invasive conservative measure for a woman who wishes to preserve fertility.
authors.affiliation: Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Maebata-cho 5-161, Tajimi, Gifu, 507-8522, Japan. gyendoscopy@gmail.com.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Takeda
authors.forename: Sanae
authors.initials: S
authors.lastname: Imoto
authors.forename: Masahiko
authors.initials: M
authors.lastname: Mori
authors.forename: Hiromi
authors.initials: H
authors.lastname: Nakamura