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Case 225: Leiomyoma.

Jason DiPoce1, Xiaolin Liu-Jarin1, Jeffrey Newhouse1

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A pregnant woman experienced severe abdominal pain due to a large pelvic mass. Imaging and biopsies during pregnancy and after Cesarean section helped characterize the mass, delaying definitive removal.

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Area of Science:

  • Reproductive medicine
  • Abdominal imaging
  • Surgical oncology

Background:

  • A pregnant patient presented with severe abdominal pain and distention in the first trimester.
  • Initial ultrasonography revealed a pelvic mass, prompting referral for further evaluation.

Observation:

  • Unenhanced magnetic resonance (MR) imaging at 8 weeks gestation showed a large mass separate from the gravid uterus and ovaries.
  • Diagnostic laparoscopic biopsy was performed, but complete mass removal was deferred to preserve the pregnancy.
  • Serial ultrasonography monitored the mass throughout gestation, with Cesarean section at 37 weeks.

Findings:

  • The mass extended from the spleen into the pelvis, displacing but not distorting the uterus and ovaries.
  • Post-Cesarean computed tomography (CT) and MR imaging characterized the mass, revealing no metastatic disease.
  • The mass showed no signal intensity loss on fat-saturated MR images, suggesting its composition.

Implications:

  • This case highlights the diagnostic challenges of large abdominal masses during pregnancy.
  • Multimodality imaging and staged surgical intervention are crucial for managing such complex cases.
  • Further surgical planning is necessary for definitive mass removal, balancing maternal and fetal outcomes.