Large, extra-abdominal leiomyoma of the round ligament with carneous degeneration

Leiomyoma of the uterine round ligament: A case report

Leiomyomas are common benign tumours that can arise in any anatomical structure containing smooth muscle. Their localization in the uterine round ligament is rare, although leiomyomas are the most frequent tumour of this structure. Leiomyomas present as inguinal, labial or intra-abdominal masses, and are often misdiagnosed as hernias or enlarged lymph nodes. The aim of the present study was to describe a rare case of a large intra-abdominal mesenchymal neoplasm arising from the right round ligament of the uterus. A 51-year-old asymptomatic female patient (gravida 3, para 3) presented herself for a routine gynaecological examination. A transvaginal ultrasound examination revealed a solid heterogeneous mass with a maximum diameter of 9 cm localized at the right parametrial space. Further preoperative evaluation using magnetic resonance imaging revealed that the mass contained solid and cystic components, which was suggestive of a mesenchymal neoplasm with possible involvement of the right ovary. Complete excision of the tumour and total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed via laparotomy under general anaesthesia. The intraoperative findings, frozen section biopsies and final histological examination of the tumour established the diagnosis of an intra-abdominal myoma of the right uterine round ligament. The majority of abdominal round ligament myomas are initially asymptomatic. The role of synchronous imaging examinations, such as ultrasonography and magnetic resonance imaging, in the diagnosis of these lesions is crucial.

Postpartum fibroid degeneration associated with elevated procalcitonin levels

Objectives

To describe a novel presentation of severely elevated procalcitonin (PCT) levels associated with postpartum fibroid degeneration.

Case presentation

We report a case of a 34-year-old woman with multiple large fibroids who was found to have fevers and a severely elevated PCT level of 34.03 ng/mL 2 days postpartum. MRI revealed carneous degeneration of her fibroids, and other etiologies such as infection were ruled out. She was successfully treated with the use of intravenous non-steroidal anti-inflammatory drugs and antibiotics, as a precaution. This report indicates procalcitonin may be elevated secondary to the inflammatory state caused by degenerating fibroids. Informed consent was obtained from all individuals included in this study.

Conclusions

Uterine leiomyomas, or fibroids, are tumors of the female reproductive tract affecting anywhere from 20–40% of women. One known complication of fibroids is degeneration, when the fibroid can infarct due to a decrease in blood supply. This can cause an inflammatory state with the release of multiple inflammatory markers. During pregnancy, routine markers such as white blood cell counts may be unreliable. Other markers such as procalcitonin are not well-studied in pregnancy. This case provides practitioners an example where the marker procalcitonin can be used to more accurately assess an inflammatory state during pregnancy. It also provides alterative diagnoses in the workup of postpartum fever.