Large Primary Ovarian Leiomyoma Causing Acute Abdomen in a Perimenopausal Woman: A Case Report and Literature Review

Abstract

Background: Leiomyomas comprise 0.5%–1% of all benign ovarian tumors and occur between adolescence and postmenopause; ∼ 80% have been reported in premenopausal women. These tumors are very rare, and ∼70 cases have been reported so far. Case: A 49-year-old nulliparous woman presented with abdominal pain, fever (39°C), and a palpable mass in her lower- and upper-abdominal areas. Computed tomography showed a soft-tissue, heterogeneous expansive mass of 14 × 19 × 16 cm dislocating her kidneys and intestines laterally and causing imprint on large blood vessels in her abdomen. There was a central area of necrosis and several irregular calcifications on the edge of the tumor. This patient had a midline laparotomy with a left adnexectomy. Intraoperatively, it was noted that the left ovary was occupied by the mass without any attachment to other organs. There was a serous cystadenofibroma on the right ovary. The large, well-circumscribed ovarian mass was extirpated. Results: After an uneventful recovery, this patient was discharged to undergo home treatment on the sixth postsurgical day. Conclusions: This tumor caused the patient's acute abdomen because the mass occupied much of the pelvis and abdominal cavity, and her pain was also due to the tumor's own secondary changes. This tumor is one of the largest leiomyomas reported recently.