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Erfani H, Chiang S, Dickinson S, Chi DS, Kim SH. When it's not ovarian cancer: A case of a massive leiomyoma with hydropic change. Gynecol Oncol Rep 2024; 53:101415. [PMID: 38798949 PMCID: PMC11126525 DOI: 10.1016/j.gore.2024.101415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
Background Uterine leiomyomas are benign tumors characterized by pelvic pain and abnormal bleeding. Their evolution can lead to degenerative changes, occasionally mimicking malignancies on imaging, presenting diagnostic challenges. Case presentation A 31-year-old nulliparous woman presented with symptoms of bloating, cramping, and abdominal distension. Imaging suggested an advanced ovarian malignancy, showing a complex adnexal mass and elevated CA-125 levels. During exploratory laparotomy, what was suspected to be ovarian cancer was instead identified as a large uterine mass on pathologic evaluation revealing a benign leiomyoma with extensive hydropic change. Conclusion This case highlights the diagnostic intricacies associated with large complex adnexal masses and illustrates how benign conditions like leiomyomas with hydropic degeneration can mimic ovarian cancer. This emphasizes the importance of comprehensive preoperative and intraoperative assessments to tailor management and avoid unindicated radical procedures.
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Affiliation(s)
- Hadi Erfani
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sarah Chiang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Shannan Dickinson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Dennis S. Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of OB/GYN, Weill Cornell Medical College, New York, NY 10065, USA
| | - Sarah H. Kim
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of OB/GYN, Weill Cornell Medical College, New York, NY 10065, USA
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Bhusal A, Rai P, Pradhan A, Agrawal A. Cystic endometriosis in a degenerated sub-serous myoma in a sub-fertile woman: A case report. Int J Surg Case Rep 2023; 105:107975. [PMID: 36940541 PMCID: PMC10036934 DOI: 10.1016/j.ijscr.2023.107975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Leiomyoma is the most common gynecologic tumor which may show atypical locations and degenerations. Cystic degeneration is said to be found in 4 % of all degenerations. Endometriosis, the presence of endometrial glands and stroma at extrauterine sites, is a common gynaecological condition seen in 10 % to 15 % of reproductive-age women usually being associated with various degrees of fertility problems. CASE PRESENTATION 40 years old woman with P1L1A2, with secondary sub-fertility for 5 years, presented with chief complaints of dysmenorrhoea for 1 year initially around the menstrual cycle relieving with analgesics but later not limited to the menstrual cycle and pain not relieving with analgesics since 1 month. The patient underwent fertility-sparing laparoscopic removal avoiding a laparotomy and definitive hysterectomy. Manual morcellation was achieved. CLINICAL DISCUSSION Cystic degeneration is rare in Leiomyoma although it is the more common gynaecological tumor in women and is associated with endometriosis probably due to retrograde menstruation. CONCLUSIONS Laparoscopic removal of leiomyoma without laparotomy and definitive hysterectomy for a case of cystic endometriosis in a degenerated subserous myoma which to the best of our knowledge according to our search of articles on the relevant topic is the first reported case pertaining to the topic from Nepal.
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Affiliation(s)
| | | | - Anju Pradhan
- Department of Pathology, BP Koirala Institute of Health Sciences, Nepal
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Mongan S, Wibowo A. Giant Uterine Leiomyoma With Surgical Difficulty. J Med Cases 2021; 12:386-390. [PMID: 34691333 PMCID: PMC8510670 DOI: 10.14740/jmc3764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/23/2021] [Indexed: 11/11/2022] Open
Abstract
Uterine leiomyoma is a benign gynecological tumor of the uterine myometrium layer in the female reproductive system, with clinical incidence in approximately 25% of women. In rare instances, it is possible for it to grow into a giant uterine leiomyoma (weighing 11.4 kg or more). Surgery on a giant mass is challenging because the enlargement mass affects the normal anatomical position of the internal genital organs. We report a case of a giant uterine leiomyoma with surgical difficulty. A 45-year-old woman came to the gynecology outpatient department referred from a district hospital with a suspected malignant ovarian cyst. The signs and symptoms were enlargement of the abdomen in the last 15 years, abdominal pain, and menstrual blood clots. An abdominal pelvic computed tomography (CT) scan with contrast revealed a regular cystic mass with multiple solid components and thick septa, probably from the adnexa. The biochemical examination revealed an increase in CA-125 serum (102.6 U/mL) with a risk of malignancy index (RMI) score of 308. Considering the size of the mass, fixed to the abdomen with umbilical hernia and suspicions of uterine or ovarian malignancy, the patient was planned for a laparotomy with collaborating digestive surgeon and urologist. The intraoperative findings were enlargement of the uterus with cystic degeneration of the leiomyoma at the posterior wall of the uterus. Due to the size of the mass, the anatomical position of the internal genital organs was deviated. The ovaries and fallopian tubes were normal, and total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. The mass measured 57 × 51 cm in size and 26 kg in weight. Histopathological examination revealed a uterine leiomyoma with cystic degeneration.
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Affiliation(s)
- Suzanna Mongan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sam Ratulangi University - Prof R.D. Kandou Hospital, Manado 95163, North Sulawesi, Indonesia
| | - Antonius Wibowo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sam Ratulangi University - Prof R.D. Kandou Hospital, Manado 95163, North Sulawesi, Indonesia
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Yamamoto A, Suzuki S. Successful surgical treatment of a giant uterine leiomyoma: A case report. Int J Surg Case Rep 2021; 87:106416. [PMID: 34537523 PMCID: PMC8449239 DOI: 10.1016/j.ijscr.2021.106416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Uterine leiomyoma is a common disease. The tumor gradually increases and becomes a target for treatment when accompanied by certain symptoms. It rarely grows into a giant uterine leiomyoma, which is defined as leiomyoma weighing >11.34 kg. Case presentation A 58-year-old Japanese woman had a history of putamen hemorrhage and deep vein thrombosis. A giant uterine leiomyoma prevented her from walking, and she scheduled surgery for its removal. The tumor was 46 × 35 × 27 cm, and the uterine arteries and veins were extremely dilated. A blocking balloon catheter was placed in the abdominal aorta to prevent massive bleeding, and a filter was placed in the inferior vena cava to prevent pulmonary thromboembolism. The surgery focused on careful vascular treatment, with selective ligation of the ovarian arteries and veins and the uterine arteries. The total amount of bleeding was 1130 g, and the uterus was removed without complications. The weight of the excised tissue was 22.6 kg. Clinical discussion Surgical treatment of the largest giant uterine leiomyomas is rare and challenging. Previous reports addressed the risk of massive bleeding and perioperative death. Surgery is the best treatment for giant uterine leiomyomas, but perioperative management and surgical procedures require complex and elaborate planning. Conclusion Very few gynecologists have experience treating giant uterine leiomyomas. Successful surgery requires careful surgical preparation, and the gynecological oncologist must have extensive experience with giant leiomyomas. Giant uterine leiomyomas are extremely rare. We report one of the world's largest cases of uterine leiomyoma. Surgical resection preceded by uterine artery ligation was successful. Sufficient preparation is necessary for safe surgery.
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Affiliation(s)
- Akihito Yamamoto
- Department of Obstetrics and Gynecology, Nippon Medical School, Japan.
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School, Japan
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Viva W, Juhi D, Kristin A, Micaela M, Marcus B, Ibrahim A, Dirk B. Massive uterine fibroid: a diagnostic dilemma: a case report and review of the literature. J Med Case Rep 2021; 15:344. [PMID: 34253260 PMCID: PMC8276390 DOI: 10.1186/s13256-021-02959-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background Fibroids of the uterus are the most common benign pelvic tumors in women worldwide. Their diagnosis is usually not missed because of the widespread and well-established use of ultrasound in gynecological clinics. Hence, the development of an unusually large myoma is a rare event, particularly in first-world countries such as Germany. It is even more uncommon that a myoma is misdiagnosed as a dietary failure. Case presentation Herein, we report the case of a Caucasian woman with a giant fibroid that reached a size of over 50 cm, growing slowly over the past 15 years, and was misdiagnosed as abdominal fat due to weight gain. We aim to discuss the factors that lead to the growth of such a huge tumoral mass, including misdiagnosis and treatment, and the psychological impact. Through this case, we intend to increase the awareness among general physicians and gynecologists. Although menstrual disorders incorporate several pathologies, adequate assessment remains the primary responsibility of health care providers. A literature review revealed approximately 60 cases of giant uterine fibroids. Conclusion The use of clinical and diagnostic devices, especially ultrasound, in this case, is indispensable. In conclusion, the growth of a giant fibroid can have disastrous effects on a woman’s health, including surgical trauma and psychological issues.
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Affiliation(s)
- Wiesener Viva
- Department of Gynecology and Obstetrics, University Medical Center UKSH, Campus Kiel, Arnold-Heller-Straße 3, Haus C, 24105, Kiel, Germany
| | - Dhanawat Juhi
- Department of Gynecology and Obstetrics, University Medical Center UKSH, Campus Kiel, Arnold-Heller-Straße 3, Haus C, 24105, Kiel, Germany. .,Spectrum Clinic and Endoscopic Research Institute, 6A and 6B Neelamber building, Shakespeare Sarani, Kolkata, West Bengal, 700020, India.
| | - Andresen Kristin
- Department of Gynecology and Obstetrics, University Medical Center UKSH, Campus Kiel, Arnold-Heller-Straße 3, Haus C, 24105, Kiel, Germany
| | - Mathiak Micaela
- Institute of Pathology, University Medical Center UKSH, Campus Kiel, Arnold-Heller-Straße 3, Haus C, 24105, Kiel, Germany
| | - Both Marcus
- Department of Radiology and Neuroradiology, University Medical Center UKSH, Campus Kiel, Arnold Heller Straße 3, Haus C, 24105, Kiel, Germany
| | - Alkatout Ibrahim
- Department of Gynecology and Obstetrics, University Medical Center UKSH, Campus Kiel, Arnold-Heller-Straße 3, Haus C, 24105, Kiel, Germany
| | - Bauerschlag Dirk
- Department of Gynecology and Obstetrics, University Medical Center UKSH, Campus Kiel, Arnold-Heller-Straße 3, Haus C, 24105, Kiel, Germany
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Akkour K, Alhulwah M, Alqahtani N, Arafah MA. A Giant Leiomyoma with Massive Cystic Hydropic Degeneration Mimicking an Aggressive Neoplasm: A Challenging Case with a Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929085. [PMID: 33785706 PMCID: PMC8019839 DOI: 10.12659/ajcr.929085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Patient: Female, 32-year-old Final Diagnosis: Leiomyoma with massive cystic hydropic degeneration Symptoms: Abdominal distension • abdominopelvic mass • pelvic pain • urinary frequency Medication: — Clinical Procedure: Surgery Specialty: Obstetrics and Gynecology • Pathology • Surgery
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Affiliation(s)
- Khalid Akkour
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mais Alhulwah
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nayef Alqahtani
- Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Maria A Arafah
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Prabhu JK, Samal S, Chandrasekar S, Subramani D, Rajamanickam S. A Massive Degenerative Leiomyoma Mimicking an Ovarian Tumor: A Diagnostic Dilemma. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J. Karthiga Prabhu
- Department of Obstetrics and Gynaecology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Sunita Samal
- Department of Obstetrics and Gynaecology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Shanmugapriya Chandrasekar
- Department of Obstetrics and Gynaecology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Divya Subramani
- Department of Obstetrics and Gynaecology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Shanmugapriya Rajamanickam
- Department of Obstetrics and Gynaecology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Chengalpattu District, Tamil Nadu, India
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Brito LGO, Ueno NL, Machado MR. Does Big Mean Evil? Giant, but Benign Uterine Leiomyoma: Case Report and Review of the Literature. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:66-71. [PMID: 33513639 PMCID: PMC10183851 DOI: 10.1055/s-0040-1721351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
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.
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Affiliation(s)
- Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Universidade de Campinas, Campinas, SP, Brazil.,Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Natalia Lysei Ueno
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Maira Rossmann Machado
- Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas da Universidade de Campinas, Campinas, SP, Brazil
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Bartoš V, Korec P, Ficek R. Giant Uterine Leiomyoma in a Young Woman as an Incidental Finding After a Car Accident: a Case Report. ACTA MEDICA (HRADEC KRÁLOVÉ) 2018; 61:29-32. [PMID: 30012247 DOI: 10.14712/18059694.2018.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Leiomyomas are the most common benign tumor of the uterus. Occasionally, they may reach an extreme dimension. The authors present a case of a 44-year old woman, who suffered a car accident as a driver of personal motor vehicle. At the hospital, a huge tumor mass filling the entire abdominopelvic cavity was incidentally detected. The patient admitted a progressive abdominal enlargement for the last 5 years. An urgent laparotomy was performed, during which a giant, well-demarcated tumor arising from the uterine body had been disclosed. It was completely surgically removed and sent for histopathology. Grossly, the tumor measured 30 × 30 × 20 cm in the largest diameters and weighed 8.1 kg. The tissue was markedly edematous with foci of massive hemorrhages and contained confluent pseudocystic formations of various sizes, filled with a fluid and fresh blood. Solid foci of rubber consistency were also visible. Microscopic examination revealed a conventional subserous uterine leiomyoma with marked regressive and degenerative changes. Giant uterine leiomyomas occur extremely rare, but because of the often unexpected finding and atypical presentation, they may represent a great diagnostic challenge for both, pathologists and clinicians. At the biopsy examination, a multiple-section sampling is very important to avoid the possibility of underlying malignancy.
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Affiliation(s)
- Vladimír Bartoš
- Department of Pathology, Faculty Hospital in Žilina, Slovakia.
| | - Peter Korec
- Department of Surgery, Faculty Hospital in Žilina, Slovakia
| | - Robert Ficek
- Department of Gynecology and Obstetrics, Faculty Hospital in Žilina, Slovakia
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Pankaj S, Nazneen S, Kumari A, Kumari J, Choudhary V, Kumari A. Fibroid Mimicking Ovarian Malignancy: A Rare Case Report. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yorita K, Tanaka Y, Hirano K, Kai Y, Arii K, Nakatani K, Ito S, Imai T, Fukunaga M, Kuroda N. A subserosal, pedunculated, multilocular uterine leiomyoma with ovarian tumor-like morphology and histological architecture of adenomatoid tumors: a case report and review of the literature. J Med Case Rep 2016; 10:352. [PMID: 27998309 PMCID: PMC5175316 DOI: 10.1186/s13256-016-1167-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/01/2016] [Indexed: 12/01/2022] Open
Abstract
Background Uterine leiomyomas are common uterine tumors, and typical cases of leiomyoma are easily diagnosed by imaging study. However, uterine leiomyomas are often altered by degenerative changes, which can cause difficulty and confusion in their clinical diagnosis. We describe the 17th reported case of a uterine leiomyoma clinically diagnosed as an ovarian tumor; however, the present case shows the most detailed radiological evaluation, including contrast-enhanced magnetic resonance imaging. We first show that a uterine leiomyoma can histologically mimic an adenomatoid tumor. Case presentation A 47-year-old premenopausal, nulliparous Japanese woman with a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia had lower abdominal pain. Ultrasonography confirmed a 6-cm mass in the right-sided space of the pelvic cavity. Magnetic resonance imaging evaluation showed that a multilocular mass was present near the uterus, and a mucinous ovarian tumor was considered. Emergency surgery due to acute abdomen was performed under the diagnosis of pedicle torsion of the ovarian tumor. During surgery, a pedunculated uterine mass without stalk torsion was seen. The mass grossly contained serous and hemorrhagic fluids in the cavities, and pathology examination confirmed that the mass was a leiomyoma with hydropic and cystic degeneration. Anastomosing thin cord-like arrangements of the leiomyoma cells mimicked the architecture of adenomatoid tumors. The tumor cells were positive for the microphthalmia transcription factor but negative for other melanoma markers. Three days postoperatively, she was discharged without sequelae. Conclusions Marked intratumoral deposition of fluids may induce the multilocular morphology of a tumor, and the cellular arrangement of the tumor cells with hydropic degeneration mimicked an adenomatoid tumor in this case. Clinicians need to be aware that a subserosal leiomyoma with cystic and hydropic degeneration can mimic an ovarian tumor, and pathologists should be aware that such leiomyomas can mimic adenomatoid tumors. Additionally, perivascular epithelioid cell tumors should not be diagnosed only based on its immunoreactivity for the microphthalmia transcription factor.
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Affiliation(s)
- Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan.
| | - Yu Tanaka
- Department of Obstetrics and Gynecology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan
| | - Koki Hirano
- Department of Obstetrics and Gynecology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan
| | - Yuka Kai
- Department of Obstetrics and Gynecology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan
| | - Kaoru Arii
- Department of Internal Medicine, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan
| | - Kimiko Nakatani
- Department of Radiology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan
| | - Satoshi Ito
- Department of Radiology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan
| | - Toshiya Imai
- Minaminokaze Clinic, 3-7-1, Sakaemachi, Kochi-city, Kochi, 780-0061, Japan
| | - Masaharu Fukunaga
- Department of Pathology, Shinyurigaoka, General Hospital, 255, Furusawa, Asao-ku, Kawasaki-city, Kanagawa, 215-0026, Japan
| | - Naoto Kuroda
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 2-13-51, Shinhonmachi, Kochi-city, Kochi, 780-8562, Japan
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Cystic Endometriosis in a Huge Degenerated Subserous Leiomyoma Mimicking Bilateral Multicystic Endometriomas in an Infertile Woman with Diminished Ovarian Reserve: A Rare Endometriotic Implantation. Case Rep Obstet Gynecol 2016; 2016:2713943. [PMID: 27057369 PMCID: PMC4789423 DOI: 10.1155/2016/2713943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/07/2016] [Indexed: 11/17/2022] Open
Abstract
Uterine leiomyomas are the most common pelvic tumor in women. Leiomyoma can show atypical locations and degenerations and may not be easily differentiated from adnexal masses. Uterine leiomyoma can undergo cystic degeneration and is said to be found in 4% of all types of degenerations. The commonest type of degeneration is hyaline seen in 60% of patients. Usually uterine leiomyoma does not present as clinical and radiological diagnostic challenge. However, when leiomyoma undergoes massive cystic degeneration they may become clinical and radiological diagnostic dilemmas. The MRI showed a huge cystic mass protruding up to the pelvis not differentiated from bilateral endometriomas and accompanying subserous myomas. Surgery revealed that the mass is not bilateral endometriomas but a huge pedunculated leiomyoma with cystic degeneration and cystic endometriosis. Endometriosis is a troubling gynecologic condition occurring in 10% to 15% of women of reproductive age and is associated with fertility problems. As a peritoneal disease, the locations of endometriotic lesions are predominantly the ovaries (96.4%), followed by the soft tissue (2.8%), gastrointestinal tract (0.3%), and urinary tract (0.2%) and other rare locations. The presented case is multiple sized cystic endometriosis (endometriomas) located in a huge pedunculated subserous leiomyoma in an infertile woman having a history of laparoscopic bilateral endometrioma surgery. Conclusion. To our knowledge, this is the first reported case for endometriotic cysts (endometriomas) located in a huge cystic degenerated leiomyoma. PubMed search revealed no report concerning endometriotic implantation in the leiomyomas.
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Giant uterine fibroids: consequences of delay in presentation. Eur J Obstet Gynecol Reprod Biol 2015; 194:251-2. [PMID: 26234203 DOI: 10.1016/j.ejogrb.2015.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/30/2015] [Indexed: 11/23/2022]
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A Case of Giant Uterine Lipoleiomyoma Simulating Malignancy. Case Rep Obstet Gynecol 2015; 2015:926961. [PMID: 26266066 PMCID: PMC4525463 DOI: 10.1155/2015/926961] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/13/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Uterine leiomyoma is the most common benign pathology in women and lipoleiomyoma is an extremely rare and specific type of leiomyoma. Here, we report an unusual case of giant pedunculated subserous lipoleiomyoma misdiagnosed preoperatively as leiomyosarcoma. Case. A 45-year-old woman admitted to our gynecology outpatient clinic for complaints of abdominal distention, tiredness, and pelvic pain for the last 6 months. Sonography and abdominal magnetic resonance imaging (MRI) showed a giant semisolid mass that filled whole abdominal cavity from pelvis to subdiaphragmatic area. A primary diagnosis of uterine sarcoma or ovarian malignancy was made. On operation, total abdominal hysterectomy with a pedunculated mass of size 30 × 23 × 12 cm and weighing 5.4 kg and bilateral salpingo-oophorectomy were performed. The histopathology revealed a lipoleiomyoma with extensive cystic and fatty degeneration without any malignancy. Discussion. The diagnosis of leiomyoma is done usually with pelvic ultrasound but sometimes it is difficult to reach a correct diagnosis especially in cases of giant and pedunculated lipoleiomyoma that included fatty tissue which may mimick malignancy. Conclusion. Subserous pedunculated giant lipoleiomyoma should be kept in mind in the differential diagnosis of leiomyosarcoma or ovarian malignancy.
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Umbilical endometriosis with giant degenerated uterine leiomyomas: A case report. GYNECOLOGIC ONCOLOGY CASE REPORTS 2014; 9:18-20. [PMID: 25426408 PMCID: PMC4241485 DOI: 10.1016/j.gynor.2014.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/27/2014] [Indexed: 12/04/2022]
Abstract
We present an unusual case of umbilical endometriosis and huge uterine leiomyomas with marked hydropic and cystic degeneration. Although umbilical tumors are uncommon, the differential diagnosis should include umbilical endometriosis, particularly in reproductive-age women. Umbilical endometriosis can be suspected from the clinical presentation, but the diagnosis should be confirmed with histological examination.
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Ezugwu EC, Iyoke CA, Ezugwu FO, Ugwu G. Successful pregnancy following myomectomy for giant uterine fibroid in an infertile woman. J Reprod Infertil 2014; 15:233-6. [PMID: 25469327 PMCID: PMC4227982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 06/17/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Giant uterine fibroid is a rare tumor of the uterus, usually symptomatic requiring surgical intervention. Uterine fibroid is generally common among black women. CASE PRESENTATION In this study, a case of 31 year old nullipara was reported who presented to the Gynaecology unit of Enugu State University Teaching Hospital (ESUTH), Nigeria with a history of progressive abdominal swelling of 8 years duration, six years duration of infertility and weight loss and dyspnoea on exertion. Physical examination and transabdominal ultrasound revealed a huge abdominopelvic mass. She had myomectomy. She had a histologically confirmed giant uterine fibroid that weighed 16.8 kg. She subsequently achieved a live birth. CONCLUSION Giant uterine fibroids are relatively rare. It poses great challenges in its management. The surgical option of management should consider the fertility preservation and aspiration of couples especially in developing countries.
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Affiliation(s)
- Euzebus Chinonye Ezugwu
- Department of Obstetrics and Gynaecology, University of Nigeria, Teaching Hospital, Enugu State, Nigeria,Corresponding Author: Euzebus Chinonye Ezugwu, Department of Obstetrics and Gynaecology University of Nigeria Teaching Hospital, Itukku- Ozalla PMB 01129, Enugu State, Nigeria. E-mail:
| | - Chukwuemeka Anthony Iyoke
- Department of Obstetrics and Gynaecology, University of Nigeria, Teaching Hospital, Enugu State, Nigeria
| | - Frank Okechukwu Ezugwu
- Department of Obstetrics and Gynaecology, Enugu State University, Teaching Hospital, Enugu state, Nigeria
| | - George Ugwu
- Department of Obstetrics and Gynaecology, University of Nigeria, Teaching Hospital, Enugu State, Nigeria,Department of Obstetrics and Gynaecology, Enugu State University, Teaching Hospital, Enugu state, Nigeria
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