Uterine Reconstruction Due to a Giant Myoma. A Case Report and Literature Review

Abstract

Giant myomas, defined as those > 9 cm, are uncommon. Due to the difficulties caused by its enormous size, the usual surgical treatment is a simple total hysterectomy. The surgery may be performed by either laparoscopy or laparotomy. However, the case presents a 45-year-old woman who was diagnosed with a giant myoma of 23 cm. The patient is asymptomatic and does not accept the indication of a simple total hysterectomy because of her fear to lose her femininity and a feeling of mutilation and unfulfilled genesic desire. A personalized procedure was performed: myomectomy by laparotomy with subsequent uterine reconstruction. The case is described to focus the interest on giant uterine myomas, taking into account the limited availability of literature on the topic, and to highlight the reconstruction after myomectomy.

Giant Uterine Leiomyoma With Surgical Difficulty

“…Histopathologic microscopic examination of uterine leiomyoma may reveal four types of degeneration forms: hyalin, cystic, myxoid or red, and dystrophic degenerations. Hyalin degeneration is the most common form of leiomyoma degeneration; in contrast, cystic degeneration only occurs in 4% of cases [6].…”

Features of the receptor apparatus of simple and prolifering uterine myoma

“…Активация белка сопряжена с увеличением его стабильности, стресс и повреждение генома увеличивают время его полураспада и, следовательно, уровень экспрессии. Эффекты белков протоонкогенов вообще патогенетически тесно связаны с пролиферативными сигналами в клетке [2,3]. При их нормальном увеличении активация носит временный характер и значимого роста не наблюдается.…”

Analysis of presurgical uterine artery embolization (PUAE) for very large uterus myomatosus; patient’s desire to preserve the uterus; case series and literature review

“…Their size and number can vary greatly. Gennaro Della Rossa et al have suggested defining myomas larger than 9 cm or more than 800 g in weight as "giant" [3].…”

“…Because of the size of the uterus, laparoscopic access is not useful in this case. In addition, there is a risk of heavy bleeding from the myoma wound bed and the risk that the uterus can no longer be preserved or reconstructed [3,8].…”