Degenerated fibroid - a diagnostic challenge
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20164677Keywords:
Fibroid, Hyaline degeneration, Leiomyoma of the uterus, TumorAbstract
Leiomyoma of the uterus is the most common type of tumor affecting the female pelvis and arises from uterine smooth muscle. The size of leiomyoma varies from microscopic to giant; giant myoma is exceedingly rare. We report an unusual case of a large, cystic, uterine leiomyoma mimicking a primary malignant ovarian tumor on sonography and CT. A 39 year old infertile nulliparous woman presented with a history of lump in abdomen since 2 years and 6 months of amenorrhea. Sonography and CT examination showed a large mass that filled the abdomen. A preoperative diagnosis of a primary malignant ovarian tumor was made. The patient underwent laparotomy with total abdominal hysterectomy preserving tubes and ovaries. The histology revealed a leiomyoma with extensive hyaline degeneration. The current established management of uterine fibroids may include expectant, surgical, or medical management or uterine artery embolization or a combination of these treatments. A surgical approach is preferred for management of giant leiomyomas. Leiomyomas should be considered in the differential diagnosis of a multilocular and predominantly cystic adnexal mass.
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References
Novak ER, Woodruff JD. Myoma and other benign tumours of the uterus.In: Novak ER, Woodruff JD, editors. Novak’s Gynaecology and Obstetric Pathology. Philadelphia: WB Saunders. 1979:260-79.
Courbiere B, Carcopino X. Gynecologie Obstetrique. Vernazobres-Greco; 2006-2007. Fibromes uterins; pp. 359-365.
Okizuka H, Sugimura K, Takemori M, Obayashi C, Kitao M, Ishida T. MR detection of degenerating uterine leiomyomas. J Comput Assist Tomogr. 1993;17:760-6.
Ueda H, Togashi K, Konishi I, Kataoka ML, Koyama T, Fujiwara T, et al. Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds. Radiographics. 1999;19 Spec No:S131-45.
Kawakami S, Togashi K, Konishi I, Kimura I, Fukuoka M, Mori T, et al. Red degeneration of uterine leiomyoma: MR appearance. J Comput Assist Tomogr. 1994;18:925-8.
Ueda H, Togashi K, Konishi I, Kataoka ML, Koyama T, Fujiwara T, Kobayashi H, Fujii S, Konishi J. Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds. Radiographics. 1999;19:131-5.
Janus C, White M, Dottino P. Uterine leiomyosarcoma-magnetic resonance imaging. Gynecol. Oncol. 1989;32(1):79-81.
Murase E, Siegelman ES. Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. 1999;19(5).
Clement PB, Young RH. Diffuse, perinodular, and other patterns of hydropic degeneration within and adjacent to uterine leiomyomas. Am J Surg Pathol. 1992;16(1):26-32.
Wladimiroff J. Ultrasound in obstetrics and gynaecology. Elsevier; 2009. Uterine fibroids.
Yarwood RL, Arroyo E. Cystic degeneration of a uterine leiomyoma masquerading as a postmenopausal ovarian cyst: a case report. J Reprod Med. 1999;44:649-52.
Reddy NM, Jain K, Gerscovich EO. A degenerating cystic uterine fibroid mimicking an endometrioma on sonography. J Ultrasound Med. 2003;22:973-6.
Cohen JR, Luxman D, Sagi J, Jossiphov J, David MP. Ultrasonic “honeycomb” appearance of uterine submucous fibroids undergoing cystic degeneration. J Clin Ultrasound. 1995;23:293-6.
Salvo DN. Sonographic imaging of maternal complications of pregnancy. J Ultrasound Med. 2003;22:69-89.
Casillas J, Joseph RC, Guerra JJ. CT appearance of uterine leiomyomas. Radiographics. 1990;10(6):999-1007.