Lugata John, Smith Caleigh, Gaffur Raziya, Mchome Bariki, Mremi Alex, Mbise Fredrick
Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, United States of America.
Int J Surg Case Rep. 2024 Nov;124:110443. doi: 10.1016/j.ijscr.2024.110443. Epub 2024 Oct 12.
Uterine leiomyomas, or fibroids, are benign mesenchymal tumors, which represent the most common tumors of the female genital tract. Their occurrence in pediatric and adolescent populations is uncommon, and relatively few cases have been documented in the literature, particularly in lower-resourced settings. This case highlights the importance of recognizing that although uncommon, fibroids can occur in much younger populations. Also highlights the need for healthcare practitioners in resource-limited environments to be vigilant in considering leiomyoma in differential diagnoses, even in younger patients, and to adapt their treatment approach given the constraints of local healthcare systems.
Here we present an uncommon case of uterine leiomyoma in a 16-year-old female from Northern Tanzania. She presented with lower abdominal pain associated with abdominal distension, prolonged menses, headache, and anemia. Transvaginal US and pelvic MRI were performed and revealed an enlarged uterus with a heterogeneous mass in the posterolateral uterine wall. Myomectomy was performed, and post-operative recovery was uneventful. The final histopathological report confirmed the diagnosis of intramural uterine leiomyoma.
In this report, we discuss the rarity of this condition, the literature surrounding similar reports, and the many challenges that arise in the management of leiomyoma in a young adolescent population.
Uterine leiomyomas should be considered as a differential diagnosis in pediatric and adolescent females presenting with a pelvic mass and abdominal pain. Though there are no specific guidelines for treatment, management of leiomyomas in this age group, should be conservative and based on symptom severity with the goal of preserving fertility.This case underscores the need for more research and awareness of uterine leiomyomas in adolescents to improve understanding and management of this rare condition in this age group, particularly in regions like Northern Tanzania where access to healthcare may be limited.
子宫平滑肌瘤，即肌瘤，是良性间叶组织肿瘤，是女性生殖道最常见的肿瘤。它们在儿童和青少年人群中并不常见，文献中记载的病例相对较少，尤其是在资源匮乏地区。本病例凸显了认识到尽管肌瘤在年轻人群中不常见，但仍可能发生的重要性。同时也凸显了资源有限环境下的医疗从业者在鉴别诊断中考虑平滑肌瘤的必要性，即使是年轻患者，并且要根据当地医疗系统的限制调整治疗方法。
我们在此呈现一例来自坦桑尼亚北部的16岁女性患子宫平滑肌瘤的罕见病例。她因下腹部疼痛伴腹胀、经期延长、头痛和贫血前来就诊。进行了经阴道超声和盆腔磁共振成像检查，结果显示子宫增大，子宫后壁外侧有一个不均匀肿块。实施了肌瘤切除术，术后恢复顺利。最终的组织病理学报告证实为子宫壁间平滑肌瘤。
在本报告中，我们讨论了这种疾病的罕见性、围绕类似报告的文献以及在年轻青少年人群中管理平滑肌瘤所出现的诸多挑战。
对于出现盆腔肿块和腹痛的儿童及青少年女性，应将子宫平滑肌瘤视为鉴别诊断之一。尽管没有具体的治疗指南，但该年龄组平滑肌瘤的管理应保守，基于症状严重程度，目标是保留生育能力。本病例强调了对青少年子宫平滑肌瘤进行更多研究和提高认识的必要性，以改善对该年龄组这种罕见疾病的理解和管理，特别是在像坦桑尼亚北部这样医疗服务获取可能受限的地区。
