Case of giant leiomyoma in 32-year-old patient
Leiomyomas are commonly occurring benign neoplasms of the female genital tract. The incidence goes from 4 to 11% to 40% in women in their 50s. Studies conducted over the years have described the different subtypes and secondary changes of leiomyomas encompassing calcifications, hyaline degeneration, hydropic degeneration and myxoid changes. The changes are important to note because of their resemblance with different forms of uterine sarcomas or ovarian neoplasms. This article describes a case of leiomyoma mimicking an aggressive neoplasm in a young woman with a challenging diagnosis.
Case study
A 32-year-old single and nulliparous (female that has not borne offspring) presented with an abdominopelvic mass. According to the patient, the mass was gradually increasing in size. Other symptoms included chronic pelvic pain, abdominal distension and urinary frequency. Despite weight loss and a decrease in appetite, her menstrual cycles were regular. Her medical history did not reveal any chronic medical illnesses, previous surgeries or any family history of gynecological cancers, which are: cervical, ovarian, uterine, vaginal, and vulvar.
Clinically the patient looked abnormally thin and weak. Physical examination, however, showed normal vital signs. On abdominal examination, the patient had a large irregular, painless and fix mass that occupied the abdominal cavity. There were no palpable lymph nodes. Doctors admitted the patient for further investigations.
Investigations and diagnosis
All laboratory tests, including haematological, biochemical tests and tumour markers were within normal range. The patient was further referred for a CT scan of the chest which showed large complex masses in the abdomen and pelvis with cystic areas. The cystic areas further enhanced solid components and caused a mass effect on the adjacent abdominal structures. In addition, compressed the inferior vena cava, without any obstruction.
Bibasilar atelectatic changes were also evident, secondary to the intraabdominal mass. However, with no signs of intra-thoracic metastases. The masses showed intermediate-to-low T2 signal intensity and avid contrast enhancement. The intraabdominal mass extended from the pelvis to the diaphragm and displaced the rectum and the uterus. The masses collectively measured 33 x 24 x 15 cm. In addition, the uterus also appeared enlarged with intramural fibroids. The left ovary was not visible, whereas the cervix and the right ovary were unremarkable.
Based on these findings, differentials included primary uterine sarcoma and primary left ovarian carcinoma. Metastasis was also suspected. Doctors suggested that the case be discussed in a multi-disciplinary tumour board. The final decision was to perform surgery and finalise a diagnosis based on intraoperative consultation.
The well-circumcised mass was sent for histopathological analysis which confirmed the diagnosis of a giant leiomyoma. The patient was discharged on the 4th day after surgery. Similarly, follow-up for the past 16 months was uneventful. She also reported a complete resolution of her GI and genitourinary symptoms. In addition, regained her appetite.
Source: American Journal of Case Reports
