Stepwise approach to a large fibroid uterus in a nulliparous woman: a case report
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20250207Keywords:
Fibroids, Leiomyoma, Menorrhagia, Myomectomy, Abdominal hysterectomyAbstract
Leiomyomas are the most common benign pelvic tumour in the reproductive age women accounting for almost 20-25% incidence in general population. Leiomyomas are monoclonal tumours of the smooth muscle cells of the myometrium containing varying amount of fibrous tissue. A 45-year-old, unmarried, nulliparous woman presents with large distended abdominal swelling and heavy bleeding during her periods at a tertiary care hospital. This case report magnifies varying risk factors, diagnosis and management of large uterine fibroids and highlights joint diagnosis and decisions of gynaecologist, radiologist and pathologist. After putting forth various modes of treatment options, the definitive treatment was decided considering her age, severity of symptoms, that is fibroid impacting her quality of life and her future parity interest. This particular case showcases successful preoperative medical treatment, timely investigations and planned surgery for optimal patient outcome.
Metrics
References
Sharma J B. Benign lesions of uterus and broad ligaments. Textbook of Gynecology. 2nd ed. 2022;506-34.
Sankaran S, Manyonda IT. Medical management of fibroids. Best Pract. Res. Clin. Obstet. Gynaecol. 2008;22(4):655-76. DOI: https://doi.org/10.1016/j.bpobgyn.2008.03.001
Ross RK, Pike MC, Vessey MP, Bull D, Yeates D, Casagrande JT. Risk factors for uterine fibroids: reduced risk associated with oral contraceptives. Br Med J (Clin Res Ed). 1986;293:359-62. DOI: https://doi.org/10.1136/bmj.293.6543.359
Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Womens Health. 2012;12:6. DOI: https://doi.org/10.1186/1472-6874-12-6
Grapsa D, Smymiotis V, Hasiakos D, Kontogianni-Katsarou K, Kondi-Pafiti A. A giant uterine leiomyoma simulating an ovarian mass in a 16-year-old girl: a case report and review of the literature. Eur J Gynaecol Oncol. 2006;27(3):294-6.
Rein MS, Barbieri RL, Friedman AJ. Progesterone: a critical role in the pathogenesis of uterine myomas. Am J Obstet Gynecol. 1995;172(1):14-8. DOI: https://doi.org/10.1016/0002-9378(95)90077-2
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. DOI: https://doi.org/10.4314/mmj.v28i1.8
Rout D, Sinha A, Palo SK, Kanungo S, Pati S. Prevalence and determinants of hysterectomy in India. Sci Rep. 2023;13:14569. DOI: https://doi.org/10.1038/s41598-023-41863-2
Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril. 2007;87(4):725-36. DOI: https://doi.org/10.1016/j.fertnstert.2007.01.093
Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997;90(6):967-973. DOI: https://doi.org/10.1016/S0029-7844(97)00534-6
Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-7. DOI: https://doi.org/10.1067/mob.2003.99
Al-Hendy A, Myers ER, Stewart E. Uterine fibroids: burden and unmet medical need. Semin Reprod Med. 2017;35(6):473-80. DOI: https://doi.org/10.1055/s-0037-1607264
Bartos V, Korec P, Ficek R. Giant uterine leiomyoma in a young woman as an incidental finding after a car accident: a case report. Acta Med (Hradec Kralove). 2018;61(1):29-32. DOI: https://doi.org/10.14712/18059694.2018.20
Lethaby A, Farquhar C. Cooke I. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev. 2000;(4):CD000249. DOI: https://doi.org/10.1002/14651858.CD000249
Ryan GL, Syrop CH, Van Voorhis BJ. Clin Obstet Gynecol. Role, epidemiology, and natural history of benign uterine mass lesions. 2005;48:312-24. DOI: https://doi.org/10.1097/01.grf.0000159538.27221.8c
Karasick S, Lev-Toaff AS, Toaff ME. Imaging of uterine leiomyomas. AJR Am. J. Roentgenol., 1992;158(4):799-805 DOI: https://doi.org/10.2214/ajr.158.4.1546595
Laughlin SK, Baird DD, Savitz DA, Herring AH, Hartmann KE. Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound-screening study. Obstet Gynecol. 2009;113:630-5. DOI: https://doi.org/10.1097/AOG.0b013e318197bbaf
Kalayci TO, Akatlı AN, Sönmezgöz F, Şamdancı ET. A giant subserosal uterine leiomyoma mimicking an abdominal mass: multimodal imaging data. Acta Med Iran. 2015;53(4):246-9.
Preayson RA, Hart WR. Pathologic considerations of uterine smooth muscle tumors. Obstet Gynecol Clin North Am. 1995;22:637-57. DOI: https://doi.org/10.1016/S0889-8545(21)00658-6
Mayer DP, Shipilov V. Ultrasonography and magnetic resonance imaging of uterine fibroids. Obstet Gynecol Clin North Am. 1995;22;667-725. DOI: https://doi.org/10.1016/S0889-8545(21)00660-4
Sohn GS, Cho S, Kim YM, Cho CH, Kim MR, Lee SR. Current medical treatment of uterine fibroids. Obstet Gynecol Sci. 2018;61(2):192-201. DOI: https://doi.org/10.5468/ogs.2018.61.2.192
Khan AT, Shehmar MJ, Gupta JK. Uterine fibroids: current perspectives. Int J Women’s Health. 2014;6:95-114. DOI: https://doi.org/10.2147/IJWH.S51083
Downloads
Published
How to Cite
Issue
Section
