Laparoscopic Ovarian-Preserving Management of Primary Ovarian Leiomyoma

Extrauterine leiomyomas, including ovarian leiomyomas, are difficult to diagnose given their rarity, especially in the absence of synchronous uterine leiomyomas or a history of a myomectomy. Primary ovarian leiomyomas have historically been managed with oophorectomy, frequently via laparotomy, due to challenges related to preoperative diagnosis and risk stratification of a solid pelvic mass.

This is the case of a 27-year-old nulliparous female who presented with 1 episode of abnormal uterine bleeding and mild intermittent left sided pain in the setting of attempting conception. Ultrasound revealed a solid adnexal mass and tumor markers were within normal limits. Laparoscopic mass removal, preserving the ovary, was performed and final pathology resulted as leiomyoma. The patient was able to spontaneous conceive shortly after surgery.

This case report highlights the feasibility of laparoscopic ovarian conserving management of primary ovarian leiomyoma following the appropriate clinical workup and patient counseling, with consideration for the patient's age and desire for future fertility.