Unaware of a large leiomyoma: A case report with respect to unusual symptoms of large leiomyomas

Abstract

IntroductionUterine leiomyoma, which arises from uterine smooth muscle, is the most common benign gynecologic tumor of the female pelvis. Clinically, these leiomyomas are diagnosed in approximately 25% of women, the prevalence increases during reproductive age, decreases after menopause, and they are rare in adolescents. In addition to uterine leiomyoma, there are also extrauterine leiomyomas.Presentation of caseA 48-year-old multiparous woman visited our outpatient clinic for routine control. She had no symptoms or complaints. Her last health service visit was over 5 years ago, in which she was told that she had a small uterine leiomyoma, which did not require further management. Abdominal examination revealed a large mass extended above the umbilicus, and there was no abdominal tenderness. Abdominal ultrasonography showed a large solid mass occupying the abdomen. Routine laboratory test results were normal, except the hemoglobin level, which was 7.88 g/dl. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The final diagnosis was a 17-cm, 3985-g intramural, myomatous, cellular leiomyoma that occurred without secondary changes, necrosis, cellular atypia, or mitosis.DiscussionThe most common presenting symptoms of large uterine leiomyomas are abnormal bleeding, dysmenorrhea, pelvic pain, and tumor bulk-related signs. Moreover, there are unusual symptoms or clinical manifestations such as acute edema, thrombosis, ulcer, plethora, calcified pelvic masses, hematometra, severe pulmonary hypertension, and respiratory failure; hence, they can be even life threatening.ConclusionPatients might have no symptoms or might be unaware of the presence of a large uterine leiomyoma, as in our case; however, large leiomyomas have various unusual symptoms in addition to the common ones. These symptoms should not be disregarded or underestimated.

Frequency and morphology of benign histopathological lesions in total abdominal hysterectomy specimens.

“…22 Leiomyomas vary in size, may develop more than 11.4 kgs. 23 In our study, the leiomyomas ranged from 0.5 to 14cm in width and 0.5 to 10cm in length.…”

Giant Fibroids: Diagnosis and Management Modality: About Two Cases and Literature Review

“…Large sizes are rare and the clinical picture is noisy [8]. We then have a significant increase in abdominal volume with a mass effect due to bladder compression (pollakiuria, hydronephrosis or renal dysfunction), digestive symptoms (constipation, hypoxemia due to the decrease in stomach volume) [9], severe oedema, thrombosis, ulcer, calcified pelvic mass, hematimetry, severe pulmonary hypertension, and lifethreatening respiratory failure [10]. And in extreme cases, white line hernia due to significant abdominal distension.…”

“…The main differential diagnosis is uterine sarcoma, a rapidly evolving peri-menopausal mass that is difficult to explore on MRI and is also diagnosed histologically [9]. Giant fibroids can also mimic an ovarian carcinoma associated with a pseudo Meig's syndrome [10].…”

Successful laparoscopic myomectomy in giant myoma

“…Uterine leiomyomas are smooth muscle tumors. [ 1 2 ] The fibroid is 2–3 times more common in black as compared to white women. [ 3 ] It is more prevalent in females of reproductive age group, decreases after menopause, and is rare in adolescents.…”

“…Out of three subserous are usually asymptomatic. [ 1 ] Almost 50% of patients are asymptomatic and some may have symptoms such as menorrhagia, dysmenorrhea, abdominal swelling, and pressure symptoms. [ 3 ] Asymptomatic myoma does not require treatment.…”