Giant Uterine Leiomyoma With Surgical Difficulty

Uterine leiomyoma is a benign gynecological tumor of the uterine myometrium layer in the female reproductive system, with clinical incidence in approximately 25% of women. In rare instances, it is possible for it to grow into a giant uterine leiomyoma (weighing 11.4 kg or more). Surgery on a giant mass is challenging because the enlargement mass affects the normal anatomical position of the internal genital organs. We report a case of a giant uterine leiomyoma with surgical difficulty. A 45-year-old woman came to the gynecology outpatient department referred from a district hospital with a suspected malignant ovarian cyst. The signs and symptoms were enlargement of the abdomen in the last 15 years, abdominal pain, and menstrual blood clots. An abdominal pelvic computed tomography (CT) scan with contrast revealed a regular cystic mass with multiple solid components and thick septa, probably from the adnexa. The biochemical examination revealed an increase in CA-125 serum (102.6 U/mL) with a risk of malignancy index (RMI) score of 308. Considering the size of the mass, fixed to the abdomen with umbilical hernia and suspicions of uterine or ovarian malignancy, the patient was planned for a laparotomy with collaborating digestive surgeon and urologist. The intraoperative findings were enlargement of the uterus with cystic degeneration of the leiomyoma at the posterior wall of the uterus. Due to the size of the mass, the anatomical position of the internal genital organs was deviated. The ovaries and fallopian tubes were normal, and total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. The mass measured 57 × 51 cm in size and 26 kg in weight. Histopathological examination revealed a uterine leiomyoma with cystic degeneration.