30. Large Uterine Leiomyoma in Premenarchal 11-year-old Patient: A Case Report

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<h3>Background</h3> Uterine leiomyomas, solid benign monoclonal tumors, are the most common pelvic tumor in women. Steroid hormones are thought to play a role in pathogenesis and they are known to increase with age in premenopausal women. These lesions are exceedingly rare in the pediatric and adolescent population and even more so in premenarchal females. <h3>Case</h3> An 11-year-old female presented with a firm abdominal mass, increasing in size over one year. She had mild cramping with intense physical activity. She denied urinary or gastrointestinal symptoms, except occasional sensation of urge without ability to void. She had no anorexia, fatigue, weight loss, or fevers. She was pre-menarchal with pubarche, adrenarche, and thelarche progressing in the preceding year. She was not sexually active. Her mother's menarche was age 12. Negative family history of cancer. On exam, she had a firm mass, measuring 23 cm from pubic bone. MRI confirmed a solid, circumscribed 8.5 × 16.5 × 15.9 cm mass with scattered areas of heterogeneity, small volume of pelvic free fluid, no lympadenopathy (figure 1). Due to concern for sarcoma, pediatric surgery performed an open biopsy. Pathology was consistent with leiomyoma. The mass was subsequently resected via a vertical midline incision. Intraoperatively, there was a firm mass originating from the anterior superior portion of the uterus, and small omental adhesion to the mass at the prior biopsy site (figure 2). A Penrose drain was tied around the base of the uterus and dilute vasopression was injected in the serosa. The mass was completely resected without entry into the endometrium. The uterus was closed from cornua to cornua in three layers. Pathology showed monomorphic proliferation of myoid cells, staining consistent leiomyoma, without coagulative necrosis or increased mitotic activity to suggest a higher grade process. Genetic testing was negative for hereditary leiomyomatosis, renal cell cancer (FH), multiple endocrine neoplasia (MEN1) and PTEN. <h3>Comments</h3> Despite the high incidence of uterine leiomyomas in women of a reproductive age, few cases have been documented in a premenarchal patient. This premenarchal status, along with the absence of any typical genetic markers for uterine leiomyomas, suggests that there may be additional factors that contribute to the development of leiomyomas.