A-39 year old, nulligravida woman with giant leiomyomas: a case report

Endy Cahyono; Teuku Mirza Iskandar; Ediwibowo Ambari; Very Great Eka Putra; Lubena; I Made Prasetya Wardana

doi:10.15562/bmj.v12i2.4275

A-39 year old, nulligravida woman with giant leiomyomas: a case report

Endy Cahyono ,

Teuku Mirza Iskandar ,

Ediwibowo Ambari ,

Very Great Eka Putra ,

Lubena ,

I Made Prasetya Wardana ,

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DOI: https://doi.org/10.15562/bmj.v12i2.4275 |
Published: 2023-04-25

Abstract

Introduction: The most common neoplasm of the uterus, uterine leiomyomas, or fibroids, are benign growths that affect 20–30% of women between the ages of 30 and 50. The smooth muscle of the uterus gives rise to leiomyomas. In this case report, we sought to highlight the case of a 39-year-old nulligravida lady with a fast expanding abdominal mass and abdominal pain.

Case Presentation: The gynecologist department at Dr. Kariadi General Hospital Semarang received a visit from a 39-year-old nulligravida lady complaining of a fast-expanding lump in her belly and extreme weight loss over the past year. During the abdominal exam, an immovable mass that could have been an 8-month pregnancy was felt in the midline of the abdominal area, extending from the lower abdomen to the epigastric area. Ascites were also discovered. The multislice computerized tomography (MSCT) results showed a solid lobulated inhomogeneous mass with internal calcification which extended from the abdominal cavity to the pelvic cavity and visualized the size of (anteroposterior 21.7 cm x laterolateral 24.1 cm x craniocaudal 36.8 cm), compressing the surrounding bowel structures, liver, spleen, and bladder. Several lymphadenopathies were also discovered. A frozen section, a bilateral salpingo-oophorectomy, and a total abdominal hysterectomy were performed. The results of the histology suggested a benign leiomyoma. Her vital signs were steady after surgery, and she fully recovered. The patient was called for a follow-up one week after being released for surgical suture removal and evaluation. The patient was discharged on the sixth postoperative day in good condition.

Conclusion: In determining if uterine smooth muscle tumors are benign or malignant, clinical characteristics, physical examination, imaging, and pathological findings are still considered very useful. The histopathology examination is still the most reliable diagnostic tool. The decision to perform a hysterectomy on this patient was determined accordingly to the tumor's size, probability of malignancy, and increasing morbidity.

References

Ernest A, Mwakalebela A, Mpondo BC. Uterine leiomyoma in a 19-year-old girl: Case report and literature review. Malawi Med J. 2016;28(1):31–3.
Hasanuddin H, Hendryan D. The similarity of a desmoid tumor with parasitic leiomyoma: a very rare case report and literature review. Bali Med J. 2022;11(1 SE-CASE REPORT):77–80. Available from: https://www.balimedicaljournal.org/index.php/bmj/article/view/3044
Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Prim. 2016;2:16043.
Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril. 2007;87(4):725–36.
Geethamala K, Murthy VS, Vani BR, Rao S. Uterine Leiomyomas: An ENIGMA. J Midlife Health. 7(1):22–7.
Mülayim B. Unaware of a large leiomyoma: A case report with respect to unusual symptoms of large leiomyomas. Ann Med Surg. 2015;4(4):431–3.
Katke R. Rare case presentation of symplastic leiomyoma in nulliparous female. Clin Cancer Investig J. 2016;5(4):323.
Moroni RM, Vieira CS, Ferriani RA, Reis RM dos, Nogueira AA, Brito LGO. Presentation and treatment of uterine leiomyoma in adolescence: a systematic review. BMC Womens Health. 2015;15:4.
Yeni CM, Maharani CR, Supriadi H. Unexpected leiomyosarcoma after total abdominal hysterectomy with indication uterine myoma in nullipara: a case report. Bali Med J. 2021;10(2 SE-CASE REPORT):775–9. Available from: https://www.balimedicaljournal.org/index.php/bmj/article/view/2395
Wilde S, Scott-Barrett S. Radiological appearances of uterine fibroids. Indian J Radiol Imaging. 19(3):222–31.
Neis KJ, Zubke W, Fehr M, Römer T, Tamussino K, Nothacker M. Hysterectomy for Benign Uterine Disease. Dtsch Arztebl Int. 2016;113(14):242–9.
Liu H-T, Wong C-N, Wong C-N, Liu F-S. Uterine smooth muscle tumor of uncertain malignant potential: A review of current knowledge. Taiwan J Obstet Gynecol. 2022;61(6):935–40.

[1] Ernest A, Mwakalebela A, Mpondo BC. Uterine leiomyoma in a 19-year-old girl: Case report and literature review. Malawi Med J. 2016;28(1):31–3.

[2] Hasanuddin H, Hendryan D. The similarity of a desmoid tumor with parasitic leiomyoma: a very rare case report and literature review. Bali Med J. 2022;11(1 SE-CASE REPORT):77–80. Available from: https://www.balimedicaljournal.org/index.php/bmj/article/view/3044

[3] Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Prim. 2016;2:16043.

[4] Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril. 2007;87(4):725–36.

[5] Geethamala K, Murthy VS, Vani BR, Rao S. Uterine Leiomyomas: An ENIGMA. J Midlife Health. 7(1):22–7.

[6] Mülayim B. Unaware of a large leiomyoma: A case report with respect to unusual symptoms of large leiomyomas. Ann Med Surg. 2015;4(4):431–3.

[7] Katke R. Rare case presentation of symplastic leiomyoma in nulliparous female. Clin Cancer Investig J. 2016;5(4):323.

[8] Moroni RM, Vieira CS, Ferriani RA, Reis RM dos, Nogueira AA, Brito LGO. Presentation and treatment of uterine leiomyoma in adolescence: a systematic review. BMC Womens Health. 2015;15:4.

[9] Yeni CM, Maharani CR, Supriadi H. Unexpected leiomyosarcoma after total abdominal hysterectomy with indication uterine myoma in nullipara: a case report. Bali Med J. 2021;10(2 SE-CASE REPORT):775–9. Available from: https://www.balimedicaljournal.org/index.php/bmj/article/view/2395

[10] Wilde S, Scott-Barrett S. Radiological appearances of uterine fibroids. Indian J Radiol Imaging. 19(3):222–31.

[11] Neis KJ, Zubke W, Fehr M, Römer T, Tamussino K, Nothacker M. Hysterectomy for Benign Uterine Disease. Dtsch Arztebl Int. 2016;113(14):242–9.

[12] Liu H-T, Wong C-N, Wong C-N, Liu F-S. Uterine smooth muscle tumor of uncertain malignant potential: A review of current knowledge. Taiwan J Obstet Gynecol. 2022;61(6):935–40.

A-39 year old, nulligravida woman with giant leiomyomas: a case report

Abstract

References

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