A rare and massive retroperitoneal leiomyoma: a case report

The objective of this case report is to describe the challenging surgical procedure of a rare, massive retroperitoneal leiomyoma and administration of postoperative circulation reconstruction, while addressing the patient's significant perioperative psychological distress.

A 52-year-old woman presented with fever and oliguria for 1 week. She presented with a giant pelvic and abdominal mass measuring 48×48×25 cm³. After multidisciplinary preparation and rectification of the mentioned detrimental symptoms, she underwent transabdominal resection with total hysterectomy and bilateral salpingo-oophorectomy. To prevent hemodynamic instability during tumor removal, a warm water bag was applied in situ during slow lifting of the mass. The 40-kg massive retroperitoneal neoplasm resulted in that the right kidney and ureter were displaced toward the abdominal midline. Throughout the tumor resection procedure, the upper one-third segment of the ureter was inadvertently transected, and a ureteral stent was placed. Postoperative pathological examination confirmed a spindle cell tumor in the right adnexal region, accompanied by hyaline degeneration and infarction, consistent with degenerative changes of leiomyoma. To reduce the risk of postoperative volume redistribution, we carried out rigorous management intraoperatively and postoperatively. Meanwhile, the patient's Hamilton Anxiety Scale (HAMA) score decreased from 21 preoperatively to 9 postoperatively, with a reduction rate exceeding 50%, confirming a marked psychological therapeutic effect.

This case emphasizes the critical role of multidisciplinary collaboration in the management of complex retroperitoneal masses and suggests that active clinical intervention can still yield favorable outcomes for patients with untreated conditions. It is worth emphasizing that psychological intervention is of great significance during her initial consultation, and empathetic and encouraging methods might be able to help her face this illness and receive treatment earlier.