An Unusual Case of Leiomyoma - Controversies in Management

A 48-year-old nulliparous woman was referred to Gynaecology for a suspected gynaecological cancer. She presented with unexplained abdominal symptoms, iron deficiency anaemia and a large pelvic mass. Her menstrual cycle was described as heavy and regular. She had a normal cervical smear history and was in the perimenopausal stage of her life. There was no reported history of weight loss. Her past gynaecological and surgical history included a previous ovarian cystectomy and appendicetomy many years ago. There was no other significant medical or family history. On examination she had a large fibroid uterus. Ultrasound scan was suggestive of a large multiloculated pelvic mass, but Ca125 was in the normal range. The pelvic mass was considered benign and she underwent a surgical treatment with total abdominal hysterectomy and bilateral salpingo-oophorectomy. During the surgery a distended fluid filled uterus was noted, with an appearance typical of a pregnant uterus. Histological examination confirmed a bizarre, symplastic leiomyoma of the uterus.