Giant Lipoleiomyoma of Cervix Mimicking as Schwannoma: First Case Report of a Dual Morphologic Variant

A BSTRACT Leiomyomas with schwannoma-like features are very rare and can resemble peripheral nerve sheath tumors, particularly if the characteristics of Verocay bodies and nuclear palisading are present. Inclusion of mature adipose tissue (lipomatous differentiation) within similar tumors is uncommon. To our knowledge, no case with cervical leiomyoma that simultaneously presents schwannoma-like and lipomatous differentiation has been reported. A 54-year-old perimenopausal woman was operated upon for assumed fibroid uterus with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Grossly, the specimen had a giant (20 cm), well-circumscribed cervical mass with bosselated surface. The cut surface was firm, grey-white with focal yellowish spots. Histology revealed a spindle cell tumor with striking nuclear palisading and Verocay body-type features, intermixed with mature adipose tissue. At first, these features were suggestive of schwannoma; however, immunohistochemistry exhibited diffuse smooth muscle actin (SMA) and desmin positivity, with S100 negativity, outlining smooth muscle lineage and categorically excluding neural origin. Lack of atypia, necrosis, or anaplastic cell proliferation further consolidated the diagnosis as benign. This represents the first documented case of a benign cervical leiomyoma exhibiting this dual morphologic pattern, underscoring the importance of recognizing such rare variants to avoid misdiagnosis.