Ovarian leiomyoma revisited: a retrospective study of 18 cases with diagnostic and therapeutic implications.

All patients underwent preoperative transvaginal gynecological color Doppler ultrasound examinations. The lesions typically exhibited hypoechogenicity, well-defined borders, round or oval shapes, regular morphology, and no foci of liquefaction or calcification in the mass (Fig.  1 ). Although color Doppler ultrasound was able to detect these lesions, it was not possible to achieve a definitive diagnosis of ovarian leiomyoma in any case. Notably, in 8 cases (44.44%), no solid ovarian masses were identified on ultrasound; these cases were proved to be ovarian leiomyoma during operation, with an average diameter of 0.962 cm. In the remaining four cases, although color Doppler ultrasound indicated the presence of ovarian masses, it could not clearly characterize the nature of the lesions. Additionally, six cases were misdiagnosed by color Doppler ultrasound as either broad ligament fibroids or subserosal uterine fibroids (Table  2 ). Fig. 1 Ultrasonographic imaging of ovarian leiomyoma localized to the ovary periphery in case 13 ( A , B ). A A hypoechoic, well-circumscribed, oval-shaped adnexal mass adjacent to the right ovary was identified by transvaginal ultrasound. The mass measured 3.49 cm × 2.34 cm. B Punctate blood flow signals around the mass were detected by color Doppler ultrasound Ultrasonographic imaging of ovarian leiomyoma localized to the ovary periphery in case 13 ( A , B ). A A hypoechoic, well-circumscribed, oval-shaped adnexal mass adjacent to the right ovary was identified by transvaginal ultrasound. The mass measured 3.49 cm × 2.34 cm. B Punctate blood flow signals around the mass were detected by color Doppler ultrasound Table 2 Imaging and tumor marker conditions of 18 patients Case TV-CDU MRI CA125(U/ml) HE4(pM) ROMA(%) AFP(ng/ml) CEA(ng/ml) CA19-9(U/ml) 1 Undetected Undetected 9.50 36.90 3.70 3.08 1.58 17.58 2 Broad Ligament Uterine Leiomyoma / 58.30 73.96 18.20 3.51 2.11 41.62 3 Undetected / / / / / / / 4 Pelvic masses of uncertain nature Sex cord-stromal tumors 21.80 31.61 5.21 3.53 0.87 <2.00 5 Pelvic masses of uncertain nature Ovarian fibroma 12.60 / / / / / 6 Undetected Undetected 19.30 45.83 6.20 2.35 1.37 20.32 7 Undetected / 14.30 / / 3.69 2.55 <2.00 8 Undetected Undetected 389.30 63.07 15.80 1.22 1.61 1153.13 9 Subserous uterine leiomyoma / 5.70 35.12 8.96 2.79 1.23 2.54 10 Undetected Undetected 55.30 45.12 6.98 1.44 1.55 32.28 11 Subserous uterine leiomyoma Ovarian fibroma 42.00 39.78 5.95 3.07 1.02 L 5.24 12 Undetected / / / / / / / 13 Pelvic masses of uncertain nature Sex cord-stromal tumors 26.20 40.80 4.54 <2.00 1.65 7.55 14 Broad Ligament Uterine Leiomyoma / 8.80 / / / / / 15 Pelvic masses of uncertain nature Pelvic masses of uncertain nature 10.90 24.36 4.56 <2.00 0.71 2.62 16 Broad Ligament Uterine Leiomyoma Ovarian fibroma 16.40 28.91 7.30 2.66 1.80 5.37 17 Undetected Pelvic masses of uncertain nature 14.20 51.27 9.33 2.74 1.70 ​<1.40 18 Broad Ligament Uterine Leiomyoma / 57.20 / / / / /​ TV-CDU Transvaginal Color Doppler Ultrasound; MRI Magnetic Resonance Imaging Imaging and tumor marker conditions of 18 patients TV-CDU Transvaginal Color Doppler Ultrasound; MRI Magnetic Resonance Imaging Of the 11 patients who underwent preoperative MRI, four cases (36.4%) showed no detectable solid ovarian masses. Intraoperative findings confirmed that these undetected ovarian leiomyomas had an average diameter of 0.98 cm. The remaining seven cases (63.6%) exhibited ovarian lesions identifiable by MRI (Fig.  2 ). However, in two cases, the nature of the lesions could not be clearly characterized by MRI. The other five cases were interpreted as ovarian sex cord-stromal tumors on MRI, including three cases suspected to be ovarian fibromas (Table  2 ). The preoperative pelvic MRI findings obtained for case 16 are also shown in Fig. 2 . Fig. 2 Preoperative pelvic MRI findings obtained for case 16. A nodular lesion exhibiting isointense signal on T1-weighted images and mildly hyperintense signal on T2-weighted images was observed at the upper outer aspect of the left uterine horn, with well-defined margins.The mass measured 2.30 cm × 1.40 cm Preoperative pelvic MRI findings obtained for case 16. A nodular lesion exhibiting isointense signal on T1-weighted images and mildly hyperintense signal on T2-weighted images was observed at the upper outer aspect of the left uterine horn, with well-defined margins.The mass measured 2.30 cm × 1.40 cm Regarding tumor markers, elevated CA125 levels were observed in five cases, and elevated CA19.9 levels were noted in two cases; all of these were associated with either uterine adenomyosis or ovarian endometrioma. Two patients demonstrated abnormally elevated levels of Human Epididymis Protein 4 (HE4) and Risk of Ovarian Malignancy Algorithm (ROMA) scores, however, postoperative pathological examination confirmed a benign ovarian leiomyoma. Among all cases tested, no abnormalities were detected in AFP or CEA levels (Table  2 ).

Eighteen cases of ovarian leiomyoma admitted to the Fujian Provincial Maternity and Children’s Hospital between 2015 and 2024 were retrospectively analyzed. This study was approved by the Ethics Committee of Fujian Provincial Maternity and Children’s Hospital. The inclusion criterion was a diagnosis of ovarian leiomyoma confirmed by postoperative pathological examination. Patients were excluded if they met any of the following criteria:1.presence of metastatic smooth muscle tumors involving the ovary (e.g., parasitic uterine leiomyoma, peritoneal disseminated leiomyomatosis, or intravenous leiomyomatosis); 2.diagnosis of ovarian smooth muscle sarcoma or other malignant ovarian tumors; 3.incomplete pathological data or missing essential follow-up information; 4.pathological sections of poor quality or insufficient for accurate diagnosis. Clinical data, including patient history, clinical manifestations, laboratory results, imaging findings, pathological assessments, treatment modalities, and prognostic outcomes, were collected from 18 patients. All pathological slides were re-examined at the onset of the study, and the diagnosis of ovarian leiomyoma was confirmed. Each patient underwent postoperative follow-up for a period ranging from one to nine years. Detailed follow-up information, including symptom response rates, surgical complications, and recurrence rates, was systematically recorded. All statistical analyses were performed using IBM SPSS Statistics (version 26.0). Continuous variables are presented as mean ± standard deviation (SD). Categorical variables are described as numbers and percentages (%).

This retrospective study included eighteen patients diagnosed with ovarian leiomyoma. The mean age was 44.78 years (range: 24–57 years). Sixteen patients (88.89%) were asymptomatic. Their pelvic masses were incidentally detected either during routine imaging examinations (Doppler ultrasound or MRI) or during surgery for unrelated conditions, such as cesarean section or myomectomy. The longest duration for which the mass remained asymptomatic was 13 years. Of the remaining patients, one had a two-year history of primary infertility, and another postmenopausal patient presented with irregular vaginal bleeding (Table  1 ). Table 1 General characteristics of the 18 patients Case Age (years) Menopause Surgical History of Uterine Leiomyoma Presence of Uterine Leiomyoma Presence of Endometriosis Presence of Adenomyosis Complaints Duration Tumor location Tumor size (diameter, cm) 1 47 Yes Yes No No No Discovered during the operation / Right 1.2 2 43 No No Yes Yes No Pelvic mass 5 years Left 7.5 3 32 No No No No No Discovered during the operation / Left 1.0 4 36 No No No No No Pelvic mass 10 months Right 3.5 5 53 Yes No Yes No No Pelvic mass, Vaginal bleeding 6 years Left 4.0 6 46 No No No Yes Yes Discovered during the operation / Left 1.0 7 47 No Yes Yes No Yes Discovered during the operation / Right 0.8 8 43 No No No Yes Yes Discovered during the operation / Left 1.2 9 55 Yes No No No No Pelvic mass 7 years Left 6.0 10 24 No No No Yes Yes Primary infertility 2 years Left 0.5 11 43 No No Yes Yes Yes Pelvic mass 3 months Left 2.0 12 36 No No No No No Discovered during the operation / Right 0.8 13 44 Yes Yes Yes No No Pelvic mass 10 days Right 2.0 14 45 No No Yes No No Pelvic mass 2 years Right 6.0 15 52 Yes No Yes No No Discovered during the operation / Right 1.0 16 52 No No Yes No Yes Pelvic mass 4 years Left 2.0 17 57 Yes No Yes No Yes Discovered during the operation / Left 1.2 18 51 No No Yes No Yes Pelvic mass 13 years Left 5.0 General characteristics of the 18 patients Of the patients, three (16.67%) had a history of surgery for uterine leiomyoma, including two who underwent total hysterectomy and one who underwent myomectomy. Additionally, ten patients (55.56%) presented with uterine leiomyoma, five (27.78%) had endometriosis, and eight (44.44%) had adenomyosis (Table  1 ). Among the cases, Case 4 had a complex past surgical history involving the right ovary. She had undergone three previous excisions of right ovarian masses at intervals of four, seven, and four years prior to the surgery included in this study. The postoperative pathological diagnoses from the first two procedures indicated right ovarian leiomyoma, while the third was reported as right ovarian fibrothecoma with endometriosis. The lesions were confined to a single ovary in all patients, with no statistically significant difference observed between the left and right ovaries ( P  > 0.05). The mean diameter of lesions measured intraoperatively was 2.59 cm (Table  1 ).

No patient in this cohort was explicitly diagnosed with ovarian leiomyoma prior to surgery. Of the total, nine patients (50%) were incidentally identified during other gynecological procedures, such as myomectomy, surgery for ovarian endometrioma, or interventions for primary infertility. Preoperatively, three patients (16.7%) were misdiagnosed with ovarian sex cord-stromal tumors, including one case (5.6%) initially considered to be an ovarian fibroma. Four patients (22.2%) were misdiagnosed with broad ligament or subserosal uterine fibroids. In two additional cases (11.1%), it was not possible to definitively distinguish between ovarian fibroma and subserosal uterine fibroid prior to surgery (Table  3 ). Table 3 Surgical and histopathological results of 18 cases Case Preoperative diagnosis Comorbidities Surgery method Surgical approach Frozen section Paraffin section Degeneration 1 / Ovarian serous cystadenoma Salpingo-oophorectomy Laparotomy Ovarian fibroma Ovarian leiomyoma None 2 Broad Ligament Uterine Leiomyoma Uterine leiomyoma,​Endometriosis Salpingo-oophorectomy Laparoscopy Benign lesion Ovarian leiomyoma None 3 / Pregnancy status Ovarian leiomyoma enucleation​ Laparotomy / Ovarian leiomyoma None 4 Sex cord-stromal tumors / Ovarian leiomyoma enucleation​ Laparoscopy Leiomyoma Ovarian leiomyoma Myxoid degeneration 5 Ovarian fibroma Uterine leiomyoma Salpingo-oophorectomy Laparoscopy Leiomyoma considered Ovarian leiomyoma None 6 / Endometriosis Ovarian leiomyoma enucleation​ Laparoscopy Mesenchymal origin Ovarian leiomyoma None 7 / Uterine leiomyoma TAH-BSO Laparotomy Leiomyoma Ovarian leiomyoma None 8 / ​Adenomyosis, Ovarian endometriotic cyst TAH-BSO Laparotomy Benign lesion Ovarian leiomyoma None 9 Subserous uterine leiomyoma / Salpingo-oophorectomy Laparoscopy Leiomyoma Ovarian leiomyoma None 10 / Ovarian endometriotic cyst Ovarian leiomyoma enucleation​ Laparoscopy / Ovarian leiomyoma None 11 Ovarian fibroma?/Subserous uterine leiomyoma? Uterine leiomyoma,​Endometriosis TAH-BSO Laparotomy Benign lesion Ovarian leiomyoma None 12 / Pregnancy status Ovarian leiomyoma enucleation​ Laparotomy / Ovarian leiomyoma None 13 Sex cord-stromal tumors Broad Ligament Uterine Leiomyoma Salpingo-oophorectomy Laparoscopy Sex cord-stromal tumors Ovarian leiomyoma None 14 Broad Ligament Uterine Leiomyoma Uterine leiomyoma Ovarian leiomyoma enucleation​ Laparoscopy Leiomyoma Ovarian leiomyoma None 15 / Ovarian serous cystadenoma, Uterine leiomyoma TAH-BSO Laparotomy Benign lesion Ovarian leiomyoma None 16 Ovarian fibroma?/Subserous uterine leiomyoma? Uterine leiomyoma TAH-BSO Laparoscopy Leiomyoma Ovarian leiomyoma None 17 / Endometrial carcinoma, Uterine leiomyoma TAH-BSO Laparoscopy Mesenchymal origin Ovarian leiomyoma None 18 Broad Ligament Uterine Leiomyoma Uterine leiomyoma,​Adenomyosis TAH-BSO Laparoscopy leiomyoma?/Ovarian fibroma? Ovarian leiomyoma None TAH-BSO Total hysterectomy with bilateral salpingo-oophorectomy Surgical and histopathological results of 18 cases TAH-BSO Total hysterectomy with bilateral salpingo-oophorectomy Details of the surgical management of ovarian leiomyoma are summarized in Table  3 . Six patients underwent ovarian leiomyoma enucleation, with a mean age of 36.5 years; none of these patients were postmenopausal. Five patients underwent salpingo-oophorectomy, with a mean age of 48.4 years. Of these, four were postmenopausal, while the remaining patient, who was premenopausal, underwent unilateral salpingo-oophorectomy due to a 7.5 cm ovarian mass and elevated preoperative HE4 tumor marker levels. Seven patients underwent total hysterectomy with salpingo-oophorectomy, all of whom had additional gynecological conditions necessitating uterine removal (including multiple uterine leiomyomas, adenomyosis, or endometrial cancer), with a mean age of 49.3 years. In this study, intraoperative rapid frozen pathology examination was not performed in only three patients; the remaining fifteen patients underwent this procedure. Among those who received intraoperative frozen section analysis, seven were diagnosed with ovarian leiomyoma, while four were identified as having benign lesions without a definitive diagnosis. The remaining four cases were misdiagnosed as ovarian sex cord-stromal tumors. Ultimately, all cases were accurately diagnosed using paraffin-embedded pathology sections(Fig.  3 ). Fig. 3 Histomorphology of ovarian leiomyoma Histomorphology of ovarian leiomyoma During postoperative follow-up, no patients experienced surgical complications or disease recurrence (Table  4 ). Table 4 Postoperative Follow-Up Data of 18 cases Case Follow-up time (years) Recurrence Situation 1 9 No recurrence 2 5 No recurrence 3 5 No recurrence 4 8 No recurrence 5 5 No recurrence 6 5 No recurrence 7 7 No recurrence 8 8 No recurrence 9 7 No recurrence 10 9 No recurrence 11 8 No recurrence 12 9 No recurrence 13 1 No recurrence 14 2 No recurrence 15 1 No recurrence 16 2 No recurrence 17 1 No recurrence 18 1 No recurrence Postoperative Follow-Up Data of 18 cases

Ovarian leiomyoma is an exceedingly rare benign ovarian tumor, comprising only 0.5%-1% of all benign ovarian neoplasms [ 1 , 2 ], Its histological features closely resemble those of uterine leiomyoma; however, the underlying mechanism of its origin remains unclear [ 3 ]. The disease predominantly affects women between the ages of 20 and 65 and typically presents unilaterally, bilateral occurrences are uncommon and are most frequently observed in young women [ 4 , 5 ]. Since its initial description in 1862, fewer than 200 cases have been documented in the literature [ 6 , 7 ]. Due to its extremely low incidence, nonspecific clinical manifestations, and diverse imaging characteristics, preoperative diagnosis is highly challenging. Consequently, it is frequently misdiagnosed as an ovarian fibroma, follicular cell tumor, or other malignant neoplasms [ 8 ]. Postoperative pathological examination remains the gold standard for diagnosing ovarian leiomyoma [ 1 ]. With the advancement of medical imaging technologies and the refinement of pathological diagnostic criteria, our understanding of ovarian leiomyoma has significantly improved. However, its pathogenesis, clinical characteristics, and optimal treatment strategies remain controversial and largely unresolved. In this study, we present 18 cases of ovarian leiomyoma and conduct a comprehensive analysis of their epidemiological characteristics, pathogenesis, clinical manifestations, diagnostic methods, and treatment strategies. Our aim is to provide a robust evidence-based foundation for clinical practice, thereby enhancing the understanding and diagnosis of this rare disease. Additionally, this study addresses current controversies and unresolved issues, offering insights and directions for future research.

In this article, we present the clinical characteristics of 18 cases of ovarian leiomyoma. Our findings indicate that most patients with ovarian leiomyoma are asymptomatic and are typically diagnosed incidentally during physical examinations or surgical procedures, consistent with previous reports [ 9 ]. When symptoms do occur, they primarily include abdominal pain, weight gain, abnormal uterine bleeding, menorrhagia, pelvic masses, or compressive manifestations such as frequent urination and constipation [ 10 ]. Rarely, ovarian leiomyomas may be associated with unusual presentations, such as Meigs’ syndrome or multiple myositis [ 11 , 12 ]. However, in our cohort, the ovarian lesions were relatively small (maximum diameter: 7.5 cm; mean diameter: 2.59 cm), which is insufficient to induce compressive symptoms. Notably, one patient in our study presented with primary infertility. Intraoperative exploration revealed that the leiomyoma was located near the ovarian surface, adjacent to the fallopian tube, potentially compressing the tube or interfering with oocyte retrieval, thereby contributing to infertility. Due to the nonspecific nature of clinical symptoms, clinicians frequently depend on imaging modalities for evaluation [ 3 ]. However, both ultrasound and MRI each have unique advantages and limitations [ 13 , 14 ]. Ultrasound is more cost-effective and convenient, yet its diagnostic accuracy can be compromised by intestinal gas, potentially resulting in missed diagnoses of small ovarian tumors. Additionally, ultrasound demonstrates considerable limitations in accurately determining the origin of pelvic tumors. In the present study, all patients underwent transvaginal gynecological color Doppler ultrasound. Ovarian tumors were identified in only ten cases (55.56%), of which six cases (60%) were misdiagnosed as uterine fibroids or subserosal uterine fibroids. This misclassification may be attributed to the close anatomical proximity of enlarged ovarian leiomyomas to the broad ligament or posterior uterine wall, as well as their similar sonographic appearance to uterine fibroids. The accuracy of ultrasound diagnosis may also be influenced by the operator’s level of experience [ 7 ]. Conversely, MRI offers a higher detection rate and superior capability in determining the origin of pelvic tumors compared to ultrasound. In this study, 11 patients underwent MRI, and ovarian tumors were detected in seven cases (63.64%), all of which were clearly localized to the ovary. Nevertheless, neither ultrasound nor MRI was able to provide a definitive preoperative diagnosis of ovarian leiomyoma. This limitation may be due to the extreme rarity of the disease, the absence of specific ultrasonographic or MRI features, and significant overlap with the imaging characteristics of other conditions such as uterine fibroids and ovarian fibromas, which contributes to a high rate of misdiagnosis [ 15 , 16 ]. Given these challenges with anatomical imaging, one might consider functional imaging. Positron emission tomography-computed tomography (PET-CT) is valuable in oncology for staging and characterizing indeterminate lesions based on metabolic activity. However, its role in further clarifying the diagnosis of ovarian leiomyoma is limited [ 9 ]. This is because: (1) it is a benign tumor typically lacking significant fluorodeoxyglucose avidity [ 17 ], (2) it is not indicated for routine evaluation of suspected benign adnexal masses due to high cost and radiation exposure, and (3) there are no established PET-CT criteria for it. Tumor markers are typically not elevated in patients with ovarian leiomyoma. In this study, some cases demonstrated increased CA125 and CA19.9 levels; however, these patients also had coexisting uterine adenomyosis or endometriosis, indicating that these conditions may contribute to the elevation of these tumor markers. Although no specific tumor marker exists for the diagnosis of ovarian leiomyoma, we recommend that tumor marker testing be performed preoperatively to exclude other potential ovarian tumors, even when ovarian leiomyoma is suspected. Pathological diagnosis remains the gold standard for confirming ovarian leiomyoma [ 18 ]. This neoplasm is characterized by the interlacing arrangement of spindle-shaped smooth muscle cells, mild nuclear atypia, and an exceedingly low mitotic index (< 1/10 high-power field). Immunohistochemically, ovarian leiomyomas exhibit strong positivity for smooth muscle markers such as α-smooth muscle actin, desmin, and h-caldesmon, while showing negativity for markers including cytokeratin and inhibin. This immunoprofile is essential for distinguishing ovarian leiomyoma from other ovarian tumors [ 19 – 21 ]. Although ovarian leiomyoma is a benign entity, it is imperative to differentiate it from the exceedingly rare ovarian leiomyosarcoma, which is highly aggressive and associated with a poor prognosis [ 22 ]. In our cohort, concurrent uterine leiomyoma was common (55.56%). Moreover, the incidence rates of endometriosis (27.78%) and adenomyosis (44.44%) observed in our patients appear to be higher than those in the general female population. Additionally, three patients had a prior history of uterine fibroid surgery, raising the possibility that their current ovarian leiomyomas may have resulted from intraperitoneal dissemination during previous surgical procedures. However, intraoperative findings in these cases revealed leiomyoma confined solely to the ovary, with no evidence of leiomyoma elsewhere in the peritoneal cavity. Collectively, these findings suggest a possible shared hormone-dependent pathogenesis among these diseases [ 5 , 23 ]. At the molecular level, these conditions commonly express estrogen receptors, further supporting the role of hormonal stimulation in their development [ 24 – 28 ]. Nevertheless, the occurrence of cases in postmenopausal women indicates that, in addition to hormonal factors, genetic mutations, growth factor dysregulation, and other mechanisms may also contribute to the pathogenesis. The tissue origin of ovarian leiomyomas remains incompletely understood. The most widely accepted theory posits that these tumors arise from the smooth muscle cells in the ovarian hilar blood vessels [ 6 , 29 ]. Alternative hypotheses suggest that ovarian leiomyomas may originate from smooth muscle cells in the ovarian ligaments, from the differentiation of multipotent stem cells within the ovarian stroma [ 30 – 32 ], These perspectives offer diverse explanations for the development of this rare tumor. Importantly, these theories are not mutually exclusive, and distinct cases may arise via different pathogenic mechanisms. Future research should integrate molecular biology techniques with analyses of larger clinical and pathological cohorts to clarify the relative contributions and potential interactions among these proposed origins. Regarding treatment strategies, individualized management remains the primary approach, encompassing both active surveillance and surgical intervention. For asymptomatic small tumors, regular and close monitoring is advisable. In contrast, surgical resection is recommended for symptomatic or larger tumors, with the choice of surgical method determined by factors such as patient age, reproductive considerations, and tumor characteristics [ 33 ]. Based on the benign biological behavior of ovarian leiomyoma, ovarian tumor resection can be performed for young patients with fertility needs. Laparoscopic surgery has become a preferred technique for ovarian leiomyomas due to its minimally invasive nature and expedited recovery [ 34 ]. However, open surgery remains necessary for large tumors or those with suspected malignancy. In our study, no recurrences were observed during the postoperative follow-up of 18 patients; however, Case four exhibited a history of multiple recurrences, with an average interval of five years between episodes. Therefore, despite the generally favorable prognosis and extremely low risk of postoperative recurrence, long-term follow-up is warranted to facilitate the early detection of potential complications. Despite growing awareness of ovarian leiomyomas in recent years, several important issues remain unresolved. For example, the molecular pathogenesis of these tumors is not yet fully understood; preoperative diagnostic accuracy requires further improvement; and there is a lack of high-quality evidence supporting treatment strategies for special populations, such as pregnant women. Moreover, compared to uterine fibroids, research on the genetic characteristics of ovarian leiomyomas is relatively underdeveloped, and the contribution of chromosomal abnormalities to their development and progression warrants further investigation.

In summary, the diagnosis of ovarian leiomyoma remains challenging, as no reliable preoperative examination currently exists to definitively identify this condition. Accurate diagnosis typically requires correlation with postoperative pathological findings. Based on the favorable outcomes observed in our limited cohort, a non-surgical, surveillance-based approach may be plausible for small (< 3 cm), asymptomatic ovarian leiomyomas with normal tumor markers (e.g., CA 19 − 9) and typical imaging features. However, careful and regular follow-up is essential. Should the lesion demonstrate significant growth or degeneration over a short period, early surgical intervention remains clinically advisable. Due to the limited number of cases, the viewpoints proposed in this study possess certain limitations. Larger sample sizes and clinical observation studies are required to provide more comprehensive and precise clinical recommendations.