Ashindoitiang John A, Canice Nwagbara Victor I, Edet Ekpo E, Ugbem Theophilus Ipeh, Ukam Joseph S, Asuquo Maurice E
Department of Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria.
Department of Obstetrics and Gynaecology, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria.
Rare Tumors. 2024 Sep 12;16:20363613241285089. doi: 10.1177/20363613241285089. eCollection 2024.
Uterine leiomyomas are common benign gynecological tumors due to the overgrowth of uterine smooth muscle. Pedunculated uterine leiomyoma occurs when the mass is in continuity with the uterus with a stalk and may grow either within the uterine cavity or outside of the uterus and may mimic ovarian neoplasms or intraabdominal tumors. Presented is a 28-year-old woman with a progressive abdominal swelling in the past 9 months seen at the surgical outpatient of our facility. Preoperative CT suggested a diagnosis of an intrabdominal cystic. She had laparotomy and was offered myomectomies on account of a large subserous uterine mass arising from the right side of the uterine fundus, small subserous fundal mass, intramural mass in the left side of the fundus and a cervical mass. Histology confirmed multiple uterine leiomyomas with extensive cystic degenerative changes of the large subserous uterine myoma and adenomyosis of the left fundal mass. Detecting the continuity of an abdominal mass even with extensive degenerative changes mimicking a cyst in continuity with the uterus by a pedicle sign on imaging in the absence of ascites should arouse the diagnosis of pedunculated subserosal leiomyoma. This should be further heightened when it is found in association with cervical myoma. Subserous uterine leiomyoma should be considered in a patient of childbearing age with a grossly distended abdomen without obvious evidence of pregnancy or malignancy. Large subserous uterine leiomyoma in an intraabdominal location may present with diagnostic and surgical challenges that require interdisciplinary cooperation.
子宫平滑肌瘤是常见的妇科良性肿瘤，由子宫平滑肌过度生长所致。带蒂子宫平滑肌瘤是指肿物通过蒂与子宫相连，可生长于子宫腔内或子宫外，可能类似卵巢肿瘤或腹腔内肿瘤。本文介绍了一名28岁女性，在我院外科门诊就诊，过去9个月来腹部逐渐膨隆。术前CT提示腹腔内囊肿。她接受了剖腹手术，因子宫底部右侧有一个大的浆膜下肿物、子宫底部小浆膜下肿物、子宫底部左侧肌壁间肿物及一个宫颈肿物，遂行肌瘤切除术。组织学检查证实为多发性子宫平滑肌瘤，其中大的浆膜下子宫肌瘤有广泛的囊性退变，左侧子宫底部肿物为子宫腺肌病。在无腹水的情况下，通过影像学上的蒂征检测腹腔肿物与子宫的连续性，即使肿物有广泛的退变改变且类似囊肿，也应警惕带蒂浆膜下平滑肌瘤的诊断。当发现与宫颈肌瘤相关时，诊断应进一步加强。对于育龄期腹部明显膨隆且无明显妊娠或恶性肿瘤证据的患者，应考虑浆膜下子宫平滑肌瘤。腹腔内的大型浆膜下子宫平滑肌瘤可能带来诊断和手术挑战，需要多学科合作。
