Primary Parasitic Leiomyoma in a Postmenopausal Woman With Neovascularisation From Omentum

Abstract

Primary Parasitic Leiomyoma in a Postmenopausal Woman With Neovascularisation From Omentum Objective: We present a rare case of primary parasitic leiomyoma in a postmenopausal woman with neo-vascularization from blood vessels in the Omentum. The published literature on primary parasitic leiomyoma is very limited and is usually reported as an unexpected incidental finding, without mention of prevalence rate. The aim of presenting this case is to document the occurrence of rare primary parasitic leiomyoma, and to review the available literature. Materials and Methods: Case details and review of literature. Results: A 50 years old postmenopausal woman presented with complaints of one episode of postmenopausal bleeding, vague dyspeptic symptoms and occasional abdominal pain, of six months duration. There was no history of previous uterine myomectomy surgery. Patient was obese and had a well-defined suprapubic mass of 16 weeks gravid uterus size. Imaging studies were inconclusive about the origin of the mass and tumor markers were within normal range. With a provisional diagnosis of benign ovarian tumor, the patient underwent exploratory Laparotomy. A mass of size 12 x 11 cm was found impacted in the pouch of Douglas. It was attached to the uterus by a thin a vascular pedicle, and was adherent anteriorly to the Omentum and loops of small intestine. There were multiple blood vessels running from the Omentum to the mass. Histopathology confirmed the mass to be a leiomyoma. Conclusion: Parasitic myomas present with nonspecific symptoms. Their infrequent occurrence and unusual location pose a diagnostic and management dilemma. Imaging studies are usually inconclusive and the mass is usually mistaken for a solid ovarian or retroperitoneal tumor. A definitive diagnosis is made only at surgery and confirmed by histopathology.