Infarcted Leiomyoma With Hyaline Degeneration Mimicking Hematometra: A Case Report

Uterine leiomyomas are common benign tumors that may undergo secondary degenerative changes, most frequently hyaline degeneration. Hemorrhagic (red) degeneration is uncommon outside pregnancy and can pose a diagnostic challenge. We report a 45-year-old hypertensive woman presenting with urinary frequency, dysuria, lower abdominal pain, and progressive abdominal distension. Examination revealed a uterus enlarged to 28-30-week size. Ultrasonography demonstrated an apparent intrauterine fluid collection, raising suspicion of hematometra or hydrometra. Cervical drainage was unsuccessful, with a possible diagnosis of organized collection. Magnetic resonance imaging showed a markedly enlarged uterus containing T1-hyperintense fluid suggestive of blood products, raising concern for malignancy. Total hysterectomy was performed. Frozen section excluded malignancy, and final histopathology confirmed an infarcted leiomyoma with hyaline degeneration and intratumoral hemorrhage. This case highlights a rare presentation of hemorrhagic degeneration in a non-pregnant woman and emphasizes the importance of histopathology in resolving the diagnostic uncertainty.