Secondary amenorrhoea with high inhibin B level caused by parasitic ovarian leiomyoma

Abstract

A 35-year-old patient attended the clinic after 1 year of primary infertility and 9 years secondary amenorrhoea. Her BMI was 21.9 kg/m². Transvaginal scan examination showed a small uterus with 1.7 mm thick endometrium. The left ovary was quiescent and measured 2.9 cm x 61.2 cm x 62.1 cm. 3D images manipulation showed a large (96.9 cm³) solid mass attached to the right ovary. Follicle stimulating hormone (FSH) level was 3.8 IU/l, oestradiol was 57 pmol/l and testosterone was 0.9 nmol/l. She had normal thyroid indices, serum prolactin, 17-hydroxyprogesterone and cortisol levels. Inhibin B and luteinising hormone (LH) blood levels were high at 408 pg/ml and 19.5 IU/l, respectively. The mass was shelled laparoscopically off the right ovary, and proved histologically to be a parasitic leiomyoma. She resumed regular menstruation 1 month after surgery and conceived in her fourth cycle. To the best of our knowledge, this is the first case to be reported relating high inhibin B and luteinising hormone blood levels to an ovarian leiomyoma.

Huge Primary Parasitic Leiomyoma in a Postmenopausal Lady: A Rare Presentation

“…Abdulwahid and associates reported parasitic fibroids in a 46-year-old lady without previous history of surgery [10]. This is similar to cases reported by Mushtaq [11] and Abdel-Gadir et al [12]. Previous surgery (laparoscopy) may not be the most significant risk factor for development of parasitic fibroids as stated by many authors.…”

Parasitic leiomyoma: A case report with literature review

“…Zaitoon reported a PL in a 40 year old female with morbid obesity without previous abdominal or pelvic operaion [1] . Abdel-Gadir et al reported a 35 year old female presented with PL apart from secondary infertility, she has not past medical or surgical history [6] . Schaudien and his colleagues reported a 70 × 28 × 35 centimeters in size and 41 kg in weight PL in a 16-year-old Hanoverian male [22] .…”

“…However PL occurring in virgin abdomen cannot be explained by this etiology. PL is an extremely rare disease with less than 30 reported cases in literature [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] . In line with SCARE guide line, we report a rare case of PL occurring a in a middle age female without history of previous abdominal operation with a brief review of literature [21] .…”

Parasitic leiomyoma presenting as an inguinal hernia in a postmenopausal woman

“…Several series have described the characteristics of postoperative or iatrogenic parasitic leiomyomas [1] , [2] , [3] . Several other reports have described the occurrence of parasitic leiomyomas in patients without pelvic surgery [4] , [6] . In our patient, the prior history of ipsilateral laparoscopic oophorectomy probably contributed to the development of parasitic leiomyoma.…”

“…Parasitic leiomyomas are considered to be pedunculated subserosal uterine leiomyomas which have lost attachment to the uterus, and have adhered to and gained blood supply from other adjacent organs. They can be found anywhere in the abdomen and pelvis, and have been reported in the omentum [4] , [5] , the ovaries [6] , and in the bowel [7] . Lete et al published the first systematic review on parasitic leiomyomas in 2016 [3] .…”