Laparoscopic Resection of a Hydropic Leiomyoma

Abstract

Video Objective We describe a resection of an asymptomatic hydropic leiomyoma presenting as either a post-surgical change or a uterine malformation, and briefly review the literature for similar case presentations. Setting A 34-year-old otherwise healthy woman was referred for resection of a uterine mass after it was incidentally discovered at the time of laparoscopic cholecystectomy. Imaging revealed a 17-cm fluid-containing mass arising from the cervix that was thought to either be a residual cyst from her prior cesarean scar or an obstructed horn of a didelphys or bicornuate uterus. Interventions The patient was taken for diagnostic hysteroscopy that revealed a normal intrauterine cavity, and diagnostic laparoscopy with laparoscopic resection of the mass using blunt bipolar dissection. The defect was repaired with 0-PDS and the mass was removed via a mini-laparotomy after enclosed morcellation in a specimen bag. Chromopertubation was performed at the end of the procedure ensuring tubal patency. Conclusion Hydropic leiomyomas are rare variants of uterine mesenchymal tumors that present in reproductive-aged women as large, indolent pelvic masses with imaging features of cystic or degenerating changes often concerning for malignancy. We describe the first case to be managed laparoscopically, and to present as a possible uterine malformation or post-surgical change, further showing the degree of the diagnostic challenge posed by hydropic leiomyomas and the importance of preoperative imaging.