A uterine leiomyoma with the prolapse large pedunculated submucosal myoma: a case report

Abstract

Introduction: Leiomyoma is a benign tumor that originates from the smooth muscle cells of the uterus and is one of the most common tumors in women. Sometimes, this tumor can become very large and even stick out of the vagina, which is called prolapse pedunculated myoma. Having a large fibroid with prolapse myoma that protrudes out of the vagina can cause problems like a low blood count or anemia, infection risk, blockage of other organs, and tissue necrosis. Therefore, this condition needs a different treatment approach than other cases. Case Report: A 50-year-old woman, P1A1, complained of bleeding from the vagina accompanied by a mass that protrudes out of the vagina, and also having an enlarged abdomen. On physical examination, the patient appears pale. Abdominal examination presence of a mass as high as the umbilicus. On a gynecological examination, Fluxus was found. In the vagina, there is a blue-black mass the size of a fist coming out of it. Hemoglobin examination obtained a result of 10.2 gr/dl. Gynecologic ultrasound examination showed the uterus with a size of more than 9.42 x 15.68 x 13.27 cm, a positive endometrial thickening, and there also appeared a hyperechoic mass with a size of 7.38 x 8.11 cm. Abdominal MSCT examination using contrast showed enlargement of the uterus with solid inhomogeneous mass and intramural calcification. There is also a mass and cervical prolapse to the perineum, mild hydronephrosis, and right proximal hydroureter. It is also found multiple lymphadenopathies in paraaortic and common iliac lymph nodes. The patient then decided to perform a total abdominal hysterectomy. Conclusion: Total abdominal hysterectomy is one of the procedures that can be done on patients who are experiencing symptoms, such as bleeding caused by a large leiomyoma size and the presence of prolapse pedunculated submucosal myoma.