A case report on leiomyoma associated with uterine anomaly

Abstract

Uterine leiomyomas are common benign smooth-muscle tumors of the uterus, whereas uterine didelphys is an uncommon Müllerian duct anomaly characterized by duplication of the uterine cavities and cervices. The coexistence of a large symptomatic leiomyoma with uterine didelphys may create diagnostic and surgical challenges because the abnormal anatomy can be difficult to recognize on routine clinical examination and ultrasonography. We report a 43-year-old multiparous woman who presented with heavy menstrual bleeding and lower abdominal pain for 9 months. On examination, the uterus was approximately 24 weeks in size and a vaginal septum was noted. Ultrasonography demonstrated a bulky uterus with multiple heterogeneous lesions suggestive of multiple fibroids. Her hemoglobin was 7.4 g/dl and she received three units of packed red blood cells preoperatively. A hysterectomy was planned because of the large symptomatic fibroid burden and completed family. Intraoperatively, a 15×15 cm leiomyoma with two additional approximately 6×6 cm leiomyomas was identified. Two separate uteri with attached cornual structures and two cervices were unexpectedly recognized during surgery. The uteri and multiple leiomyomas were removed in toto, and histopathology confirmed leiomyoma. This case highlights the importance of considering Müllerian anomalies when pelvic examination and imaging findings do not completely explain the anatomy. Careful preoperative assessment and anticipation of altered pelvic anatomy are important for safe surgical management of large leiomyomas associated with uterine anomalies.