Large uterine pyomyoma in a perimenopausal female: A case report and review of 50 reported cases in the literature

Abstract

Pyomyoma is a rare complication, which withoug antibiotics or surgical intervention, may cause sepsis and mortality. The present study reported a case of large uterine pyomyoma in a perimenopausal female. A 53-year-old multigravida woman was referred to the Department of Obstetrics and Gynecology (Wakayama Medical University, Wakayama, Japan) due to progressive abdominal distension. The patient presented with anemia gravis, severe inflammatory reaction and cachexia. Computed tomography revealed a large unilocular mass, 50 cm in size, with an irregular surface and thickened wall, occupying the entire abdomen. Following antibiotic medication, the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Intraoperative findings demonstrated a solid tumor arising from the back of the uterine body. A total of 12 liters of purulent, malodorous fluid was drained from the tumor. The resected mass was 50 cm in size and 13.5 kg in weight. Cultures of the pus revealed the presence of Streptococcus agalactiae. Pathological findings revealed suppurative leiomyoma with no malignancy. Large pyomyoma is difficult to distinguish from a gynecological malignant tumor types, particularly in perimenopausal women with non-specific clinical presentation. Although pyomyoma is a benign tumor, care must be taken to discriminate these from large abdominal tumors.

Total laparoscopic hysterectomy of an endocervical pyomyoma over previous cesarean section wound

“…The incidence of pyomyoma has decreased due to the development of antibiotics. [ 2 ] Pyomyoma occurs most commonly during the premenopausal period, postmenopausal status, pregnancy or the immediate postpartum period, as well as arises after uterine instrumentation, after uterine artery embolization (UAE), or in immunocompromised patients. The mode of infection could be ascending, which the most likely cause of pyomyoma is direct infection of bacteria in a vascular compromise, hematogenous, or lymphatic spread.…”

“…The mode of infection could be ascending, which the most likely cause of pyomyoma is direct infection of bacteria in a vascular compromise, hematogenous, or lymphatic spread. [ 1 2 3 4 5 6 7 ] As pyomyoma is a rare condition, therefore the diagnosis is difficult. This case presented some uncertain symptoms and was difficult to identify from the imaging.…”

Spontaneous Ruptured Pyomyoma in a Nulligravid Female: A Case Report and Review of the Literature

“…However, the presentation in postmenopausal women may be similar to malignancy, with symptoms of abdominal distension/bloating, anorexia, and change in stools [ 13 ]. CA-125 may also be elevated [ 14 ]. Imaging is often nonspecific; diagnosis cannot truly be made until the time of surgery [ 14 ].…”

“…CA-125 may also be elevated [ 14 ]. Imaging is often nonspecific; diagnosis cannot truly be made until the time of surgery [ 14 ]. Ultrasound shows heterogeneous uterine masses, sometimes with cystic components or air [ 1 , 3 ].…”

“…Rupture is suggested on imaging by disruption of the wall of the pyomyoma, along with free intraperitoneal fluid and air [ 1 ]. Mortality rate estimates range from 6% to 21% in the era of antibiotics [ 5 , 8 , 14 , 16 ]. Prior to the development of antibiotics in 1945, the mortality rate was 29% according to case series [ 17 ].…”