Large Leiomyoma Research Articles

Unusually large leiomyoma of buccal mucosa – Clinical case report

Leiomyomas are benign smooth muscle tumors, which occur most commonly, in the uterine myometrium, gastrointestinal tract, skin, and lower extremities of women. Only 1% of leiomyomas occur in the head-and-neck region. A thorough differential diagnosis is required before undertaking surgical excision of a lesion as it mimics fibromas, lipomas, and sometimes, leiomyosarcomas. We report a case of a 40-year-old male with an unusually large leiomyoma on the right buccal mucosa, which was present for 4 years. A complete surgical excision of the lesion was done. There was no recurrence of the lesion seen anywhere in the oral cavity.

Unusually large leiomyoma of buccal mucosa: Clinical case report

Unusually large leiomyoma of buccal mucosa: Clinical case report

Acute urinary retention due to a large isthmic leiomyoma – a case report and literature review

Acute urinary retention due to a large isthmic leiomyoma – a case report and literature review

A large submucous uterine leiomyoma and pregnancy: clinical case

A large submucous uterine leiomyoma and pregnancy: clinical case

Uterine torsion in the second trimester of pregnancy with a large leiomyoma identified in a cesarean section for abruptio placentae: a case report and literature review

The authors report a case of uterine torsion in the second trimester pregnancy with a large leiomyoma. A 28-year-old pregnant woman with a leiomyoma approximately 15 cm in size, was diagnosed with preterm premature rupture of membranes (pPROM) and abruptio placentae at 23 weeks and 0 days of gestation. Because the fetal heart rate pattern was extremely variable and decelerated to lower than 70 bpm before a prolonged deceleration to approximately 80 bpm, an emergency cesarean section was performed. Uterine torsion was identified after the uterine incision was sutured. The uterus was rotated 150 degrees clockwise, and the uterine incision had therefore unfortunately been performed in the back wall of the uterus. Because torsion was suspected to result from an increase in uterine size, the existence of a leiomyoma was viewed as the main cause of uterine torsion in this second trimester of pregnancy. This case indicates that it is important to consider the potential risk of uterine torsion when indicated, especially in cases with a risk of having a large leiomyoma.

Особливості гемодинаміки тіла матки залежно від її об’єму та ступеня васкуляризації вузлів, які досліджували за допомогою методу тривимірної допплерографії, у хворих з лейоміомою

with leiomyoma using doppler sonography there is information about the fact that the degree of uterus blood supply in this disease is associated with its proliferative capacities.Use of three-dimensional power doppler sonography allows to evade a subjective assessment of organs and tumors vascularization, present in two-dimensional doppler sonography, by quantitative evaluation of vascular blood flow intensity with calculation of volume indices of uterine body vascularization in female patients with leiomyoma.We decided to conduct this study to develop a standardized approach to the search of differential and diagnostic dopplerometric signs of leiomyoma and uterine sarcoma predictors. The objective: to study peculiarities of uterine body hemodynamics depending on its volume and vascularization degree in lumps of fertile age patients with leiomyoma, with three-dimensional doppler sonography. Materials and methods. 238 women aged 18 to 39 years were examined (Me=28.5). The main group consisted of 127 (53.36%) fertile age women aged 27 to 39 years (Me=33.0) with uterine leiomyoma, found during ultrasonography.All of them were divided into further sub-groups: women with small and large leiomyomas, and they, in their turn, into women with uterine leiomyoma of moderate vascularization with single color loci peripherally in the mode of two-dimensional power flow mapping and women with uterine leiomyoma of profound vascularization with a great amount of color loci both peripherally and in the center in the mode of two-dimensional power flow mapping.The comparison group consisted of 111 (46.6%) of apparently healthy women aged 18 to 39 years (Ме=28.5), in which uterus examination allowed to develop new and improve the existent nomograms of uterine body blood flow values (VI, FI, VFI) and develop uterine cervix nomograms. In case of three-dimensional (3D) reconstruction of the uterus using power mapping and options of VOCAL (Virtual Organ Computer-aided Analysis), an objective assessment of hemodynamics of the uterine body was carried out by calculating the vascularization index (VI) that characterizes the percentage of color voxels in the volume of the uterine body, index of flow intensity (FI) that shows median brightness of the color voxels depending on the flow velocity in a predetermined three-dimensional volume, and vascularization flow index (VFI) that is a measure of organ perfusion and is the product of vascularization index and flow index divided by 100. Results. In the fertile period the study three-dimensional blood flow indices values, reflecting hemodynamics of uterus, affected by leiomyoma, depended on uterine body volume (Kruskal–Wallis test, p<0.05), falling to the bottom boundary of reference values of the comparison group progressively as the uterine body volume increases by more than 370 cm3 (large uterine leiomyoma) subject to moderate vascularization of lumps, and approaching with some exceedence to median values of norm subject to significant vascularization (CC, Mann-Whitney U-test; p<0.05).Therefore uterine body volume of 370 cm3 we consider the differential criteria, which allows to get oriented in the dynamics of the indices under study. Characteristics of small (less than 370 cm3) uterine leiomyoma values under study depended on lumps vascularization degree: if vascularization was medium, practically no differences from norm were observed, and if vascularization was profound, the significant exceedence in comparison groups nomograms values was obvious (Mann–Whitney U-test; p<0.05). Conclusion. Obtained regularities in changes of uterine body hemodynamics depending on its volume and vascularization degree in lumps of fertile age patients with leiomyoma, with three-dimensional doppler sonography, opens new prospects of the search of differential and diagnostic dopplerometric signs of leiomyoma and uterine sarcoma.Use of standardized diagnostic approach should considerably increase the sensibility and specificity of three-dimensional power doppler sonography method in diagnostics of leiomyoma and uterine sarcoma in future. Key words: three-dimensional power Doppler sonography, hemodynamics of the uterine body, uterine leiomyoma, uterine sarcoma, uterine body volume, lumps vascularization degree.

Leiomyoma of the Urinary Bladder: A Review and Update

Leiomyoma of the urinary bladder / leiomyoma of the ureter is a very rare benign tumour of smooth muscle origin which has been reported sporadically globally. Leiomyoma of the urinary bladder/ureter may be diagnosed incidentally during investigation of various conditions including infertility and hepatitis. Leiomyoma of the urinary bladder / ureter may manifest in female as well as in a male patient with non-specific symptoms including lower urinary tract symptoms / retention of urine, haematuria, loin pain/discomfort, urinary tract infections and cystitis. The general and systematic examinations may be normal but at times there may be a palpable mass within the area of the urinary bladder on bimanual examination but not always. There may occasionally be tenderness in the loin. The results of routine haematology and biochemistry blood tests would generally tend to be normal but there may be anaemia and impairment of renal function some cases of visible haematuria and obstruction of the ureter respectively. Ultrasound scan would tend to illustrate a well-circumscribed polypoidal soft tissue mass projecting into the urinary bladder or within the intramural area of the bladder. Intravenous urography would show a filling defect in the urinary bladder. CT and MRI scans of abdomen and pelvis with contrast would show a well-defined round mass in the area of the bladder which could be iso-tense to skeletal muscles on T1 and T2 weighted images and occasionally may show cystic areas of necrosis. Cystoscopy would show the lesion projecting into the urinary bladder at the specific area of the urinary bladder involved and at times the projecting lesion would be covered by normal looking urothelial mucosa and on other occasions when the lesion is large and in the area of a ureteric orifice the specific ureteric orifice would not be visualized. Diagnosis of leiomyoma of the urinary bladder / ureter would be confirmed upon histopathology and immunohistochemistry study features of trans urethral resection biopsies of the lesion which would tend to show smooth muscle spindled-cells with no evidence of atypia, or necrosis, or haemorrhage and associated with a low Ki67 index. Trans-urethral resection of the urinary bladder lesion tends to be undertaken for small to medium sized lesions with good outcome but this tends to be associated with about 18% recurrence rate that would require further resections or surgical excision to ensure complete removal of the lesion and no further recurrences. Surgical excision of the lesion including partial cystectomy, local excision / enucleation have been very effective for the treatment of larger leiomyomas with no reported recurrence so far; nevertheless, patients who undergo augmentation cystoplasty or total cystectomy and urinary diversion would need to cope with the functional problems related to the cystoplasty or urinary diversion. Differential diagnoses of leiomyoma of the urinary bladder / ureter include leiomyosarcoma, urothelial carcinoma and other malignant lesions affecting the urinary bladder. There is need for clinicians to explore minimal invasive surgery to treat patients who have leiomyoma of the bladder / ureter especially those who have multiple co-morbidities and the alterative management options that could be undertaken in multi-centre trials include: Cryotherapy, radiofrequency ablation, irreversible electroporation, high frequency ultrasound treatment and super-selective embolization of the arterial branch supplying the leiomyoma. Patients who develop ureteric obstructions would additionally require nephrostomy insertions or insertion of ureteric stents as a temporary measure to improve their renal functions.

Uterine Artery Embolization Prior to Laparoscopic Hysterectomy for a Large Fibroid Uterus

Video Objective The objective of this video was to present the use of uterine artery embolization prior to supracervical hysterectomy of a large fibroid uterus Setting A 40 year old woman, gravida 0, with a history of heavy menses, bloating, back pain and pelvic pressure presented to her primary care physician for symptomatic anemia and notable family history of fibroids. The patient reported a history of regular, monthly menses however noted an interval increase in her vaginal bleeding. Her past medical history was notable for anemia for which she was taking iron supplementation. She was found to have numerous large uterine leiomyomas on magnetic resonance imaging, with the largest measuring 12.6 centimeters on the anterior body of the uterus. Physical examination was notable for a 26cm, bulky uterus extending up to the liver edge and xiphoid process. The patient declined uterine artery embolization and Lupron as initial treatment for fibroids. She instead elected for definitive surgical management, and strongly desired a minimally invasive approach. Interventions Uterine artery embolization and ureteral stent placement immediately followed by laparoscopic supracervical hysterectomy, bilateral salpingectomy and cystoscopy with stent removal Conclusion This case is unique in its collaboration between interventional radiology, urology and gynecology to ensure the safest outcome for the patient. Use of uterine artery embolization immediately prior to laparoscopic hysterectomy for large uterine leiomyomas is beneficial in decreasing intraoperative blood loss and thereby improving visualization as well as decreasing morbidity during minimally invasive laparoscopic surgery. Furthermore, placement of ureteral stents intraoperatively allows identification of the ureters when pelvic anatomy is distorted by fibroid location and size. Distortion of pelvic anatomy can limit the use of a uterine manipulator but is not a contraindication to proceeding with minimally invasive technique.

1896 Primary Solitary Anterior Abdominal Wall Leiomyoma

Study Objective To present a case of primary solitary large anterior abdominal wall leiomyoma Design Leiomyomas are said to be the most common benign tumor of the female reproductive tract. They are frequently found in the uterus, however they can also be found in the broad ligament, ovaries, fallopian tubes, vagina and, very rarely, on the abdominal wall. Abdominal wall leiomyomas are rare and usually thought to be associated with previous surgical resection of uterine myomas. Setting The patient was placed in lithotomy Trendelenburg position and under general anesthesia. Patients or Participants N/A Interventions Robotic-assisted mass excision was performed, and the specimen was carefully removed from a mini-laparotomic incision. Measurements and Main Results A 42 year-old woman, with no history of prior uterine surgeries, presented with a lump in the right lower abdomen which had been progressively increasing in size for months. Ultrasound revealed an anterior abdominal mass, with a diameter of about 9 cm, with no evidence of uterine myomas or ovarian tumors. To exclude the possibility of malignancy, the patient underwent robotic-assisted mass excision. Histopathology of the anterior wall mass showed a leiomyoma with diffuse coagulation tissues (weighted at 213 g). Conclusion Abdominal wall leiomyoma is an uncommon finding and is thought to be related to seeding following uterine myomectomies; however, the patient in this case had never undergone any uterine surgeries. The precise cause of the origin of primary abdominal wall leiomyoma is not clear at present. Transformation of the smooth muscle cell of the vessel wall in the anterior abdominal layer to leiomyoma may play a role. It is hypothesized to be associated with somatic mutation or interaction of hormonal and growth factors. In conclusion, benign primary leiomyoma of the abdominal wall is a differential diagnosis to be considered in women with an anterior abdominal mass and no histories previous uterine surgeries.

2351 The da Vinci SP® Surgical System has an Advantage in Performing Surgery on a Giant Uterine Leiomyoma Weighing 2340g

Study Objective To describe the experience of robotic-assisted single port supracervical hysterectomy with bilateral salpingectomy on a giant uterine leiomyoma using the da Vinci SP surgical system. Design A Case report. Setting Robot Surgery Center of Ewha Womans University Hospital. Patients or Participants A 45-year old virgin woman with huge uterine leiomyoma sized about 26 × 23cm2. Interventions Robotic-assisted single port SCH with BS using the da Vinci SP surgical system. Measurements and Main Results The recently introduced da Vinci SP surgical system include a fully wristed camera which can offer an easy movement of camera and instruments to 360 degree at once. Therefore this surgical system has an advantage on the surgery which requiring procedures both below and above the umbilicus with only the single incision inside the umbilicus. We present a case of huge uterine leiomyoma of intramural type measured about 26 × 23cm2 which is successfully performed the SCH with BS using the da Vinci SP system. Total operative time was 145 minutes and the estimated blood loss was 250 mL. The hospital stay was 2.5 days. No operative or postoperative complications occurred. To the best of our knowledge, this is the largest leiomyoma case of robotic-assisted single port SCH using the da Vinci SP system and we have known the advantage of the da Vinci SP® surgical system on the huge intraabdominal mass requiring procedures above the umbilicus level as in this case. Conclusion The da Vinci SP surgical system enables easy rotation of camera and instruments at once and this make it easy to perform the procedures which are performed above the umbilicus for the huge uterine leiomyoma reaching the diaphragm.

EP31.16: Cystic degeneration of large leiomyoma of uterus: a diagnostic challenge

EP31.16: Cystic degeneration of large leiomyoma of uterus: a diagnostic challenge

Critically High Carboxyhemoglobin Level following Extensive Hysteroscopic Myomectomy

Studies have demonstrated that during hysteroscopic myomectomy with bipolar diathermy, carbon monoxide is produced and enters the patient's circulation. However, little is known regarding the immediate or long-term sequelae of transient rises in carboxyhemoglobin levels during hysteroscopic surgery. This paper aims to suggest recommendations for acute evaluation, management, patient counseling, and future research. We present a case of a 36-year-old woman (Gravida 0, Para 0) with abnormal uterine bleeding-leiomyoma and resultant anemia, undergoing hysteroscopic resection of a large submucous myoma. During surgery, the patient was found to have a critically elevated level of carboxyhemoglobin and accompanying electrocardiogram derangements. She was managed with prolonged intubation, 100% O2, and trending of her carboxyhemoglobin levels before extubation. This demonstrates the importance of being cognizant of the potentially toxic gaseous byproducts of bipolar resection and of including intravasation of these byproducts in one's consideration of patient safety during extensive resections. Bipolar hysteroscopic resection of large leiomyomas may result in critically high carboxyhemoglobin levels, which can impair end-organ oxygen delivery with resultant ischemia; the risks of myocardial ischemia should be discussed with the anesthesia team before attempting an extensive resection. Electrocardiogram changes indicative of ischemia should prompt discontinuation of the case. Finally, carboxyhemoglobin poisoning should be included in the differential diagnosis of patients who demonstrate longer-than-expected anesthesia recovery times after bipolar resection of large submucous leiomyomas, and they should be managed with repeat evaluation of carboxyhemoglobin levels, supplemental oxygen, and cardiac monitoring.

Rare case of an anorectal leiomyoma

Introduction. Leiomyoma is a kind of benign tumors of smooth muscle origin, occurring mostly throughout the genitourinary system. They are rarely found in the anorectal region, where they represent less than 0.1% of the tumors of the rectum. Due to this exceptional occurrence, we report a case of leiomyoma arising in the anorectal region. Case outline. A 43-year-old otherwise healthy woman presents with the big mass in analorectal region. Major complain is pain and discomfort while sitting. Magnetic resonance imaging is done and pathohistology report confirmed large leiomyoma. Abdominoperianeal resection of the rectum was performed due to the size of the tumor. Postoperative course was uneventful. Conclusion. There is no gold standard technique, and decision about the best surgical approach for all pathohistological types of tumors in the anorectal region. The decision sometimes has to be made according to size and major complains.

Αdnexal cystic lymphangiomas in patients with massive leiomyomatous uterus: a not so uncommon finding on pelvic MRI.

To investigate any association between the presence of an adnexal cystic lymphangioma (ACL) and an enlarged leiomyomatous uterus. A retrospective observational study was conducted by two expert radiologists using a 10-year MRI database (2008-2018); 85 patients (mean age: 45.5years ± 10.9) were considered eligible due to the presence of a single (n = 31) or multiple (n = 54) leiomyomas causing distortion of the uterine contour and uterine enlargement. The association of specific leiomyoma features (longest diameter (Dmax), location, number) and uterine volume with the presence of ACL was statistically tested. Diagnosis of ACL was based on typical imaging features (n = 14) and intraoperative/histological findings (n = 3). ACL (unilateral = 9, bilateral = 8) was recorded in 17/85 (20%) of patients; it was more frequently observed when the largest leiomyoma was located in the uterine fundus (33.3%). Patients with ACL had significantly more leiomyomas (median: 5 vs. 2, p = 0.043), greater Dmax of largest leiomyoma (median: 13.3 vs. 7.2cm, p < 0.001), and larger uterine volumes (median: 676.7 vs. 223.1cm3, p < 0.001) compared to patients without ACL. ROC curve analysis for a number of leiomyomas showed that the optimal cut-off for the prediction of ACL was the presence of 5 leiomyomas with 53.8% sensitivity and 84% specificity (AUC = 0.65, 95% CI 0.51-0.83, p = 0.049), Dmax of largest leiomyoma 9.1cm with 76.5% sensitivity and 77.9% specificity (AUC = 0.83, 95% CI 0.73-0.94, p < 0.001), and uterine volume 311cm3 with 71% sensitivity and 75% specificity (AUC = 0.79, 95% CI 0.66-0.92, p < 0.001). The presence of ACL is significantly associated with number of leiomyomas, Dmax of largest leiomyoma, and uterine volume; prospective evaluation of our results is needed to investigate its clinical significance.

Endoscopic submucosal dissection of large leiomyoma of the esophagus with subsequent closure of the defect with a mucosal flap

Taking into consideration the results of our clinical observation, we can argue that the technique of endoscopic submucosal dissection of large leiomyoma of the esophagus with subsequent closure of the defect with a mucosal flap is applicable in clinical practice. This method is relatively safe, allows to achieve complete, quality results of morphological study, helps to reduce the number of postoperative complications, compared to more invasive surgical interventions. Also it reduces the time of social recovery and contributes to preserving the quality of life after the treatment.

A Large Uterine Leiomyoma with Hypertrophied Omental Vessels: A Case Report

A Large Uterine Leiomyoma with Hypertrophied Omental Vessels: A Case Report

Large uterine leiomyoma presenting as pseudo-Meigs’ syndrome with an elevated CA 125: Case report and literature review

Introduction: Uterine leiomyomas presenting as pseudo-Meigs’ syndrome with an elevated CA 125 are rare and pose a diagnostic challenge for physicians.

Cervical Stump Fibroidpost Supra-cervical Hysterectomy

Objective: To describe of a rare case of cervical stump fibroid presenting as a late complication of supra-cervical hysterectomy. Methods: A 68-year old-female with a history of lower abdominal pain and distention for six months with increasing intensity was referred from a local clinic to the department of radio-diagnosis for evaluation. She had a history of subtotal hysterectomy previously. On ultrasonography and computerized tomography imaging studies, a large adnexal lesion was noted suggesting the possibility of a cervical stump leiomyoma. The patient underwent an elective surgery and the diagnosis was confirmed in the context of histological findings. Results: Patient was operated for the radiologically diagnosed large cervical stump leiomyoma which was laterhistologically confirmed with an uneventful recovery. Conclusions: Imaging investigations like computerized tomography and magnetic resonance imaging are valuable in the diagnosis of rare adnexal masses from cervical stump arising as late delayed complications of supra-cervical hysterectomy. Keywords: Cervical stump leiomyoma, computerized tomography, magnetic resonance imaging, supra-cervical hysterectomy DOI: 10.15850/ijihs.v6n2.1257

Cervical Stump Fibroidpost Supra-cervical Hysterectomy

Objective: To describe of a rare case of cervical stump fibroid presenting as a late complication of supra-cervical hysterectomy. Methods: A 68-year old-female with a history of lower abdominal pain and distention for six months with increasing intensity was referred from a local clinic to the department of radio-diagnosis for evaluation. She had a history of subtotal hysterectomy previously. On ultrasonography and computerized tomography imaging studies, a large adnexal lesion was noted suggesting the possibility of a cervical stump leiomyoma. The patient underwent an elective surgery and the diagnosis was confirmed in the context of histological findings. Results: Patient was operated for the radiologically diagnosed large cervical stump leiomyoma which was laterhistologically confirmed with an uneventful recovery. Conclusions: Imaging investigations like computerized tomography and magnetic resonance imaging are valuable in the diagnosis of rare adnexal masses from cervical stump arising as late delayed complications of supra-cervical hysterectomy. Keywords: Cervical stump leiomyoma, computerized tomography, magnetic resonance imaging, supra-cervical hysterectomy DOI: 10.15850/ijihs.v6n2.1257

Pregnancy with “mimicking placenta previa and large cervical leiomyoma” caused by incarcerated retroverted uterus

Pregnancy with “mimicking placenta previa and large cervical leiomyoma” caused by incarcerated retroverted uterus