Leiomyoma with abscess inside

Case Report

Abstract

Background: Uterine leiomyoma is a common disease. The tumor does not cause symptoms at first, but as the tumor gradually increases, patients come to us with typical symptoms of obstruction and abdominal mass, which only arise when the size is massive.

Clinical case: A 48-year-old woman with a history of intestinal occlusion with restricted urine flow, dyspnea, abdominal pain, and a palpable mass, for which she comes to the service for care. The tumor measured 27x20x20 cm, abscessed with 200 cc of purulent fluid and weighed 7.200 kg.

Discussion: Uterine leiomyoma is a benign gynecological tumor originating from smooth muscle cells that affects up to 80% of women. Of these, only 20 to 30% have symptoms. Multiple risk factors are associated with the development of leiomyomas, the most common being nulliparity, obesity, early menarche, African ancestry and age, all of them secondary to prolonged exposure to estrogens or genetic predisposition. Uterine myomatosis affects 40% of women over 35 years of age. It is a benign neoplasia made up of smooth muscle. The most frequent region is the body of the uterus but it can occur in the cervix and exceptionally it extends towards the broad ligaments, splitting its two peritoneal layers (intraligamentary). Eventually, myomas can suffer hyaline, cartilaginous degeneration, aseptic, calcium, fatty, edematous, sarcomatous or cystic necrosis. Cystic degeneration occurs in only 4% of cases. Depending on their location, myomas can be submucosal, intramural or subserous; the latter may become pedunculated and mimic a malignant epithelial ovarian neoplasm.

Conclusion: The present case highlights the importance of a high index of clinical suspicion and a multidisciplinary approach in the management of giant uterine leiomyomas.