GIANT UTERINE MYOMA AND OVARIAN MYOMA - ASSOCIATION OF TWO RARE ENTITIES. CASE REPORT AND LITERATURE REVIEW

  • Anda PRISTAVU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Alina MARES “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • A. NANDREAN “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • A. CARAULEANU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Demetra SOCOLOV “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • V.G. RUGINA “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • A. HAMOD “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Mihaela GRIGORE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
Keywords: UTERINE LEIOMYOMA, GIANT LEIOMYOMA, GIANT MYOMA, LARGE MYOMA, OVARIAN MYOMA

Abstract

Uterine myomas are the most common benign tumors of female reproductive system. They affect 25% of women of reproductive age. Giant uterine myomas are quite rare and are a challenge both for a complete diagnosis and for surgical management. Extra-uterine myomas are rare and they usually appear in the genitourinary tract (ovaries, vulva, broad ligament, round ligament, urethra). Primary ovarian leiomyoma is one of the rarest solid tumors of the ovary accounting for 0.5%–1% of all benign ovarian neoplasms. We report a 45-years-old nulliparous woman who came with abdominal distension and fatigue for several months. Abdominal-pelvic ultrasound and computer tomography showed a large myoma-like mass that filled the pelvis and abdomen. The diagnosis of giant uterine myoma was established and after careful discussion with the patient total hysterectomy was proposed. Surgery confirmed the diagnosis of a giant uterine myoma with several parasitic omental blood supplies. An additional ovarian myoma was discovered and total hysterectomy with right adnexectomy was performed. Our case stresses several clinical points that should be kept in mind before planning a surgery for a giant myoma - the possible presence of parasitic blood vessels and adherences which can pose some difficulties for the surgical team and the coexistence of different pathologies masked under the size of the tumor. It is important before planning a surgery to discuss with the patient the possibility to adapt the surgery according to associated pathology.

Author Biographies

Anda PRISTAVU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Mother and Child Medicine

Alina MARES, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

1. Medis Medical Centre, Iasi
2. Arcadia Medical Hospital, Iasi

A. NANDREAN, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Mother and Child Medicine

A. CARAULEANU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Mother and Child Medicine

Demetra SOCOLOV, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Mother and Child Medicine

V.G. RUGINA, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Mother and Child Medicine

A. HAMOD, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Mother and Child Medicine

Mihaela GRIGORE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Mother and Child Medicine
Medis Medical Centre, Iasi

References

1. Buttram VC Jr, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 1981; 36: 433-445.
2. Fasih N, Prasad AK, Macdonald DB, Fraser MA, Papadatos D, Kielar AZ, et al. Leiomyomas beyond the uterus: unusual locations, rare manifestations. Radiographics 2008; 28(7): 1931-1948.
3. Van Winter JT, Stanhope CR. Giant ovarian leiomyoma associated with ascites and polymyositis. ObstetGynecol 1992; 80: 560-563.
4. Safaei A, Khanlari M, Azarpira N, Monabati A. Large ovarian leiomyoma in a postmenopausal woman. Indian J Pathol Microbiol 2011; 54: 413-414.
5. Doss BJ, Wanek SM, Jacques SM, Qureshi F, Ramirez NC, Lawrence WD. Ovarian leiomyomas: clinicopathologic features in fifteen cases. Int J Gynecol Pathol 1999; 18: 63-68.
6. Takeda A, Mori M, Sakai K. Parasitic peritoneal leiomyomatosis diagnosed 6 years after laparoscopic myomectomy with electric tissue morcellation: report of a case and review of the literature. J Minim Invasive Gynecol 2007; 14: 770-775.
7. Odofin O, Nasir N, Satyadas T, Lower AM, Akle C. An unusual case of ectopic or "parasitic" leio-myoma excised by laparoscopic surgery. Int Surg 2004; 89(3): 161-163.
8. Murase E, Siegelman ES, Outwater EK, Perez-Jaffe LA, Tureck RW. Uterine leiomyomas: histopath-ologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics 1999; 19: 1179-1197.
9. McLucas B. Diagnosis, imaging and anatomical classification of uterine fibroids. Best Parct Res Clin Obstet Gynaecol 2008; 22: 627-642.
10. Aydin C, Eriş S, Yalçin Y, ŞenSelim H. A giant cystic leiomyoma mimicking an ovarian malignancy. International Journal of Surgery Case Reports 2013; 4(11): 1010-1012.
11. Cărăuleanu A., Socolov R., Anghelache Lupaşcu Ivona, Rugină V., Socolov Demetra. Giant intraliga-mentary uterine leiomyoma and its complications. Rev Med Chir Soc Med Nat 2016; 120(1): 145-151.
Published
2017-12-22