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© Borgis - New Medicine 3/2014, s. 89-91
*Konrad Wroński1, 2
Giant uterine leiomyoma – case report and review of literature
1Department of Oncology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
Head of Department: prof Sergiusz Nawrocki, MD, PhD
2Department of Surgical Oncology, Hospital Ministry of Internal Affairs with Warmia and Mazury Oncology Centre, Olsztyn, Poland
Head of Department: Andrzej Lachowski, MD
Summary
Uterine leiomyomata are the most common gynecological benign tumors arise from the smooth muscle cells of the myometrium. The pathogenesis of fibroids is still unclear. Leiomyomas are found in more than half of women over age 35. About 70% of Caucasian women and 80% of African American women have uterine leyomyomata above 50 years of age. Most of patients have small uterine leiomyoma. Giant uterine leiomyoma with cystic degeneration are exceedingly rare and can be mistaken for ovarian or retroperitoneal cysts and neoplasmatic tumor.
The author of this article presented a case of a 63-year-old Caucasian woman who was admitted to the hospital because of giant uterine leiomyomata which mimicking a huge ovarian malignancy and cause torsion. The patient underwent radical abdominal hysterectomy and bilateral salpingoophorectomy without complication. The author performed a literature review on giant uterine leiomyomata treatment.
INTRODUCTION
Uterine leiomyomata are the most common gynecological benign tumors arise from the smooth muscle cells of the myometrium (1-3). The pathogenesis of fibroids is still unclear (2, 3). Leiomyomas are found in more than half of women over age 35 (1-4). About 70% of Caucasian women and 80% of African American women have uterine leyomyomata above 50 years of age (5). Most of patients have small uterine leiomyoma (5, 6). Giant uterine leiomyoma with cystic degeneration are exceedingly rare and can be mistaken for ovarian or retroperitoneal cysts and neoplasmatic tumor (6, 7).
CASE REPORT
A 63-year-old Caucasian woman was referred to the Department of Surgical Oncology due to giant pelvic tumor diagnosed in computer tomography scan (fig. 1, 2). The computed tomography scan revealed cystic-solid polycyclic mass adherent to the stem of the uterus, which after intravenous injection of contrast agent underwent strengthening mainly within the peripheral solid tumors. The largest transverse dimension at the level of iliac was 242 x 173 millimeters. Tumor mass extended from the level of the lower edge of the right lobe of the liver to the upper wall of the bladder, the peripheral outline of polycyclic calcification were visible. In the adnexal revealed no changes. The bladder was thin-walled. In the other organs of the abdomen, there were no focal lesions. The lymph nodes were not enlarged during the scope examined. In bones, there were no lesions suspected of metastasis. The basal layer of both lungs were unchanged.
Fig. 1. The computed tomography scan showing cystic-solid polycyclic mass adherent to the stem of the uterus.
Fig. 2. The computed tomography scan showing giant uterine fibroid tumor which the largest transverse dimension at the level of iliac was 242 x 173 millimeters.
The patient suffered from abdominal pain located in the the mesogastric and the lower abdomen area, she had distension and constipation for a period of 16 months. Physical examination showed palpable tumor located in the mesogastric and the lower abdomen area. There were no peritoneal symptoms. The external genitalia and uterine cervix were normal. Her vital signs were all within normal limits. There was no histopathological examination of the fine-needle aspiration biopsy before planned surgery.
She had no any other symptoms, there was no history of weight loss and loss of appetite. The patient was treated chronically due to diabetes and arterial hypertension. She had no surgeries and there was no history of carcinoma in patient family. Blood test and other routine hematological examinations and biochemical tests were within normal limits.

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Piśmiennictwo
1. Cramer S, Patel A: The frequency of uterine leiomyomas. Am J Clin Pathol 1990; 94: 435-438. 2. Gupta S, Manyonda I: Acute complications of fibroids. Best Pract Res Clin Obstet Gynaecol 2009; 23: 609-617. 3. Tsai Y, Yeats S, Jeng C, Chen S: Torsion of a uterine leiomyoma. Taiwan J Obstet Gynecol 2006; 45: 333-335. 4. Tordera A, Bello T, Bouteiller J: Acute abdomen casued by calified pediculated myoma. Dia Med 1952; 24: 1523-1524. 5. Adams Hillard PJ: Benign diseases of the female reproductive tract. [In:] Berek JS, ed. Berek and Novak’s gynecology. 14th ed. Philadelphia: Lippincott and Williams, 2007: 463-469. 6. Vandermeer FQ, Wong-You-Cheong JJ: Imaging of acute pelvic pain. Clin Obstet Gynecol 2009; 52: 2-20. 7. Roy C, Bierry G, El Ghali S et al.: Acute torsion of uterine leiomyoma: CT features. Abdom Imaging 2005; 30: 120-123. 8. Fields KR, Neinstein LS: Uterine myomas in adolescents: case reports and a review of the literature. J Pediatr Adolesc Gynecol 1996; 9: 195-198. 9. Wisot AL, Neimand KM, Rosenthal AH: Symptomatic myoma in a 13-year-old girl. Am J Obstet Gynecol 1984; 105: 639-641. 10. Augensen K: Uterine myoma in a 15-year-old girl. Acta Obstet Gynecol Scand 1981; 60: 591. 11. Evans III AT, Pratt JH: A giant fibroid uterus. Obstet Gynecol 1979; 54: 385-386. 12. Novak ER, Woodruff JD: Myoma and other benign tumors of uterus. [In:] Novak ER, Woodruff JD editors. Novak’s gynecologic and obstetric pathology. Philadelphia: WB Saunders 1979: 260-267. 13. Preayson RA, Hart WR: Pathologic considerations of uterine smooth muscle tumors. Obstet Gynecol Clin North Am 1995; 22: 637-657. 14. Mayer DP, Shipilov V: Ultrasonography and magnetic resonance imaging of uterine fibroids. Obstet Gynecol Clin North Am 1995; 22: 667-725. 15. Chopra S, Lev-Toaff AS, Ors F, Bergin D: Adenomyosis: common and uncommon manifestations on sonography and magnetic resonance imaging. J Ultrasound Med 2006; 25(5): 617-627.
otrzymano: 2014-07-14
zaakceptowano do druku: 2014-08-19

Adres do korespondencji:
*Konrad Wroński
General Surgery Consultant Department of Surgical Oncology Faculty of Medicine University of Warmia and Mazury, Olsztyn
37 al. Wojska Polskiego, 10-228 Olsztyn, Poland
e-mail: konradwronski@wp.pl

New Medicine 3/2014
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