Management of uterine giant myoma

Does Big Mean Evil? Giant, but Benign Uterine Leiomyoma: Case Report and Review of the Literature

Uterine leiomyoma is the most prevalent benign type of gynecological tumor. It affects more than 80% of women worldwide and, within this group, more than 50% may be asymptomatic. However, large fibroid volumes may be associated with symptoms of extrinsic compression, and most of the cases do not present atypical cells. We present the case of a 49-year-old woman who underwent a total abdominal hysterectomy of a 13.5-kg uterine leiomyoma with no malignancies at histopathology and review the literature about giant uterine leiomyomas and their clinical repercussion. We concluded that large volumes do not always pose a threat regarding malignancy; however, future molecular studies are needed to investigate giant uterine fibroids.

Giant uterine leiomyomata

OBJECTIVE

To present the case of a patient with giant uterine leiomyomata and review literature pertinent to the subject.

DESIGN

Case report and literature review.

SETTING

A major university, tertiary-care hospital.

PATIENT(S)

One patient, with said pathology, who gave informed consent for exploratory laparotomy, total abdominal hysterectomy, and bilateral salpingo-ophorectomy.

INTERVENTION(S)

Exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-ophorectomy, reoperation with abdominal washout, and hemostasis for hemoperitoneum.

MAIN OUTCOME MEASURE(S)

Not applicable.

RESULT(S)

Not applicable.

CONCLUSION(S)

Those with giant uterine leiomyomata are a very unique and tiny subset of the millions of women with fibroids. They should be treated similarly to older, more critically ill patients. Their optimal surgical management requires the careful attention to considerations and techniques not common to the typical myomectomy or hysterectomy.

Total laparoscopic hysterectomy for uteri over one kilogram

INTRODUCTION

Laparoscopic hysterectomy for large fibroid uteri is technically a difficult procedure. In this article, we report our experience with fibroid uteri >1 kg in weight.

MATERIALS AND METHODS

An intent-to-treat study.

RESULTS

From 2003 to 2009, 13 patients were successfully treated for large fibroid uteri with postoperative specimens weighing >1000 g. Four patients had total abdominal hysterectomy, one patient had laparoscopically assisted vaginal hysterectomy, and 8 patients had total laparoscopic hysterectomy. The last 6 cases were total laparoscopic hysterectomy cases.

CONCLUSION

With experience and specialized techniques, total laparoscopic hysterectomy can replace abdominal hysterectomy for large uteri.