International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Panda SR et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):863-865

www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: 10.18203/2320-1770.ijrcog20150111
Case Report

A rare case of leiomyoma of uterus with cystic degeneration

Soumya Ranjan Panda*, Charu Chandra

Department of Obstetrics & Gynecology, AIIMS, Jodhpur, Rajasthan, India

Received: 11 March 2015

Accepted: 19 April 2015

*Correspondence:
Dr. Soumya Ranjan Panda,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Leiomyoma of the uterus is the most common tumor of the female pelvis. The size of leiomyomas varies from
microscopic to giant. Giant myomas are exceedingly rare. Here, we present a case of a woman with uterine myoma
that had undergone cystic degenerative changes, mimicking an ovarian malignancy. It provided a lot of diagnostic
challenge as even ultrasonography and CT scan were not confirmatory. Finally laparotomy was done keeping
everything ready for the management ovarian malignancy. On laparotomy the mass was found to be leiomyoma of
uterus with cystic degeneration.

Keywords: Leiomyoma, Cystic degeneration

INTRODUCTION associated with clots & not associated with pain lower
abdomen. There was heaviness in lower abdomen for last
Leiomyoma of the uterus is the most common tumor of 1 month.
the female pelvis, which arises from uterine smooth
muscle. Such tumors are found in nearly half of women M/H - Previous Menstrual Cycles 5/30 days, avg. flow.
over age 35; the prevalence increases during reproductive
age and decreases after menopause. The estimated For last 3 months 8/30 days, increased flow, associated
incidence is 20%-40% in women during their with clots.
reproductive years.1-4 The size of leiomyomas varies from
microscopic to giant. Giant myomas are exceedingly LMP - 10 days back.
rare.5 Appropriate surgical management and careful
perioperative care are necessary to obtain a good result O/H - P3003, LCB- 4 Year back, using barrier method of
after removal.6 Here, we present a case of a woman with contraception.
uterine myoma that had undergone cystic degenerative
changes, mimicking an ovarian malignancy. P/H - She was not a known case of hypertension, diabetes
or any other chronic diseases.
CASE REPORT
F/H - No family history of malignancies.
Patient Dhapu Devi 32 year Hindu female from Guda,
Jodhpur, presented with chief complaints of heavy O/E - GC fair, mild pallor.
menstrual bleeding for 3 months, heaviness in lower
abdomen for 1 month. P/A - A well-defined globular mass in hypogastrium, 16
week size, soft, lower limit could not made out.
She was apparently alright 3 months back. To start with
she developed increased flow during menstruation, P/S- CX, vagina healthy, ant vaginal wall bulging.

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 Panda SR et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):863-865

P/V - A mass of variegated consistency predominantly

cystic occupying the anterior fornix palpated, uterus
could not be felt separately from the mass.

D/D - 1) Fibroid with degenerative changes 2) Adnexal

mass

Consequently ultrasonography was done to differentiate

the origin of mass. The results of routine laboratory
testing including a complete blood count, serum
electrolyte levels, tests of liver and renal function and Pap
smear were normal.

Ultrasonography of pelvis showed mass with solid & Figure 2: CT scan picture showing the mass.
cystic components S/O malignant ovarian mass.

Her CA 125 & CEA were within normal limits, but Ca

19-9 was 81 (increased).

As the clinical findings & ultrasonographic findings were

not correlated CT scan of abdomen & pelvis was done.

On CT scan uterus was not separately seen, no E/O

ascites. Large well defined thick wall cystic hypodense
mass lesion in midline pelvis with internal enhancing soft
tissue contents as described, likely represent neoplastic
lesion of ?uterine origin, less likely ovarian etiology. Figure 3: CT scan picture showing the mass.

Laparotomy was planned keeping everything ready for

the management of ovarian malignancy. On opening the
abdomen a large 16 week size uterine mass was found.
Bilateral ovaries and fallopian tubes were healthy. On cut
section straw coloured fluids came out S/O cystic
changes.

Specimen was sent for histopathologic examination.

Histopathology revealed leiomyoma with cystic changes.
Post-operative period was uneventful patient discharged
on 7th post-operative day after removal of stitches.
Figure 4: Picture at laparotomy showing fibroid
uterus with bilateral healthy ovaries.

DISCUSSION

Large uterine fibroids can cause pain, constipation,

increased frequency of micturition and menstrual
bleeding. They can also affect reproduction by causing
infertility, miscarriage and/or premature labor. 1,2,5-7 As
leiomyomas enlarge, they can outgrow their blood
supply, resulting in various types of degeneration, such as
hyaline, cystic, myxoid or red degeneration and
dystrophic calcification.8 Hyalinization is the most
common type of degeneration, occurring in up to 60% of
cases. Cystic degeneration, observed in about 4% of
leiomyomas, may be considered extreme sequelae of
edema.9

Only few cases of giant uterine tumors have been

reported in the recent literature. The largest uterine
Figure 1: Ultrasonographic picture showing the mass.
fibroid ever reported weighed 63.3 kg and was removed

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 4 · Issue 3 Page 864
 Panda SR et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):863-865

postmortem in 1888.10 The potential for uterine Funding: No funding sources

leiomyomas to grow to an extreme size before causing Conflict of interest: None declared
symptoms is quite remarkable. This is likely due to the Ethical approval: Not required
relatively large volume of the abdominal cavity, the
distensibility of the abdominal wall and the slow growth REFERENCES
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in the differential diagnosis of a multilocular and
predominantly cystic adnexal mass. Sometimes the DOI: 10.18203/2320-1770.ijrcog20150111
confusion is so much that the clear picture is revealed Cite this article as: Panda SR, Chandra C. A rare case
only at laparotomy. of leiomyoma of uterus with cystic degeneration. Int J
Reprod Contracept Obstet Gynecol 2015;4:863-5.

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