MEDICAL IMAGES
Giant Uterine Leiomyoma Mimicking Pregnancy Demetrios Moris, MD, and Spiridon Vernadakis, MD, PhD, M.Sc, FEBS
A
39-year-old woman gravida 0, para 0 presented to our surgical department with a 4-month history of progressive constipation, increasing abdominal size, back pain, vague abdominal pressure sensations and urinary frequency. At admission, she stated that she was pregnant and this child was “a gift from God’’. Medical history revealed several hospitalizations due to mental illness. Blood tests and gynecological consultation excluded pregnancy. Physical examination revealed a 36-week-sized uterus (Figure 1). Transabdominal ultrasound and computed tomographic scanning suggested a giant abdominopelvic mass without ascites, metastases, or
enlarged pelvic or para-aortic lymph nodes. After psychological support, the patient consented to surgical treatment. An exploratory laparotomy with a midline incision revealed a giant mass that protruded from the incision (Figure 2). Abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy was performed (Figure 3). Macroscopically, the specimen was a 28.1 kg uterine leiomyoma measuring 623921 cm (Figure 4), well circumscribed, with solid nodules that were white or tan, with a whorled appearance on histological cuts. The postoperative course was uneventful and the patient was discharged on the 10th postoperative day.
FIGURE 1. Preoperative appearance of the patient’s abdomen.
FIGURE 3. Abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy.
FIGURE 2. Mass protruding from midline incision.
FIGURE 4. The 28.1 kg uterine leiomyoma measured 623921 cm.
Mayo Clin Proc. n June 2014;89(6):e53-e54 n http://dx.doi.org/10.1016/j.mayocp.2013.06.029 www.mayoclinicproceedings.org n ª 2014 Mayo Foundation for Medical Education and Research
From the 1st Department of Surgery, Athens University School of Medicine, “Laikon” General Hospital, Athens, Greece (D.M.), and Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Germany (S.V.).
e53
MAYO CLINIC PROCEEDINGS
By definition, giant uterine leiomyomas weigh more than 11.4 kg and are very rare. They represent a great diagnostic and therapeutic challenge because of the often atypical presentation and the possibility of underlying malignancy, mainly leiomyosarcoma. A history of growing abdominal mass, back pain, and urinary disturbances is almost universally
e54
Mayo Clin Proc.
n
present. Imaging such as computed tomography and magnetic resonance imaging, along with evaluation of tumor markers, can provide clues for the histological status of the tumor. Because there is potential for underlying malignancy, the treatment of choice is transabdominal hysterectomy with bilateral oophorectomy.
June 2014;89(6):e53-e54
n
http://dx.doi.org/10.1016/j.mayocp.2013.06.029 www.mayoclinicproceedings.org
Giant Uterine Leiomyoma Mimicking Pregnancy Demetrios Moris, MD, and Spiridon Vernadakis, MD, PhD, M.Sc, FEBS
A
39-year-old woman gravida 0, para 0 presented to our surgical department with a 4-month history of progressive constipation, increasing abdominal size, back pain, vague abdominal pressure sensations and urinary frequency. At admission, she stated that she was pregnant and this child was “a gift from God’’. Medical history revealed several hospitalizations due to mental illness. Blood tests and gynecological consultation excluded pregnancy. Physical examination revealed a 36-week-sized uterus (Figure 1). Transabdominal ultrasound and computed tomographic scanning suggested a giant abdominopelvic mass without ascites, metastases, or
enlarged pelvic or para-aortic lymph nodes. After psychological support, the patient consented to surgical treatment. An exploratory laparotomy with a midline incision revealed a giant mass that protruded from the incision (Figure 2). Abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy was performed (Figure 3). Macroscopically, the specimen was a 28.1 kg uterine leiomyoma measuring 623921 cm (Figure 4), well circumscribed, with solid nodules that were white or tan, with a whorled appearance on histological cuts. The postoperative course was uneventful and the patient was discharged on the 10th postoperative day.
FIGURE 1. Preoperative appearance of the patient’s abdomen.
FIGURE 3. Abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy.
FIGURE 2. Mass protruding from midline incision.
FIGURE 4. The 28.1 kg uterine leiomyoma measured 623921 cm.
Mayo Clin Proc. n June 2014;89(6):e53-e54 n http://dx.doi.org/10.1016/j.mayocp.2013.06.029 www.mayoclinicproceedings.org n ª 2014 Mayo Foundation for Medical Education and Research
From the 1st Department of Surgery, Athens University School of Medicine, “Laikon” General Hospital, Athens, Greece (D.M.), and Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Germany (S.V.).
e53
MAYO CLINIC PROCEEDINGS
By definition, giant uterine leiomyomas weigh more than 11.4 kg and are very rare. They represent a great diagnostic and therapeutic challenge because of the often atypical presentation and the possibility of underlying malignancy, mainly leiomyosarcoma. A history of growing abdominal mass, back pain, and urinary disturbances is almost universally
e54
Mayo Clin Proc.
n
present. Imaging such as computed tomography and magnetic resonance imaging, along with evaluation of tumor markers, can provide clues for the histological status of the tumor. Because there is potential for underlying malignancy, the treatment of choice is transabdominal hysterectomy with bilateral oophorectomy.
June 2014;89(6):e53-e54
n
http://dx.doi.org/10.1016/j.mayocp.2013.06.029 www.mayoclinicproceedings.org
