Giant myomas of the uterus

A giant cystic leiomyoma mimicking an ovarian malignancy

INTRODUCTION

Leiomyoma of the uterus is the most common type of tumor affecting the female pelvis and arises from uterine smooth muscle. The size of leiomyomas varies from microscopic to giant; giant myomas are exceedingly rare. We report an unusual case of a large, cystic, pedunculated uterine leiomyoma mimicking a primary malignant ovarian tumor on sonography and CT.

PRESENTATION OF CASE

A 58-year-old postmenopausal nulliparous woman presented with a history of lower abdominal pain and distension for a period of approximately 12 months. The patient's personal history revealed difficulty in walking, tiredness and recent weight gain of approximately 25 kg. Sonography and CT examination showed a large mass that filled the abdomen. A preoperative diagnosis of a primary malignant ovarian tumor was made. The patient underwent laparotomy, total hysterectomy and bilateral salpingo-ooferectomy. The histology revealed a leiomyoma with extensive cystic degeneration.

DISCUSSION

The current established management of uterine fibroids may involve expectant, surgical, or medical management or uterine artery embolization or a combination of these treatments. A surgical approach is preferred for management of giant leiomyomas.

CONCLUSION

Pedunculated leiomyomas should be considered in the differential diagnosis of a multilocular and predominantly cystic adnexal mass.

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.

Management of uterine giant myoma

BACKGROUND

Giant myomas of the uterus are uncommon, particularly in developed countries.

CASE

This report illustrates a case of a woman with a bilobated giant myoma of the uterus weighed in total 27.7 kg. The patient had an abdominal distension first noted 18 months before and the personal history evidenced difficulties in walking and tiredness. Abdominal hysterectomy and bilateral salpingo-oophorectomy were carried out.

CONCLUSIONS

The knowledge of the different clinical manifestation of these myomas may allow to face that with adequate perioperative care, in order to assure a carefully and successfully surgery, although sometimes a benign pathology may be not easy to suspect in a first time.