Large symptomatic uterine leiomyoma treated with total hysterectomy
DOI:
https://doi.org/10.5281/zenodo.21917538Keywords:
leiomyoma, uterine myomatosis, hysterectomy, abnormal uterine bleeding, case reportAbstract
Objective: To describe a case of a large symptomatic uterine leiomyoma treated with total abdominal hysterectomy by laparotomy.
Methods: We report the case of a 49-year-old woman, G3P3, with a history of recurrent abnormal uterine bleeding previously treated with progestogens, who presented with metrorrhagia and progressive abdominal enlargement.
Results: Physical examination revealed a fibroelastic hypogastric mass of approximately 20×10 cm, and transvaginal ultrasound documented a myomatous uterus measuring 16×12×9 cm and weighing about 860 g, with subserosal, transmural and submucosal fibroids, the largest 60×40 mm. Given uterine size —exceeding thresholds generally accepted for a laparoscopic approach (major axis ≥12 cm, weight >600 g)— total abdominal hysterectomy by laparotomy was chosen.
Conclusion: This case illustrates the progression of symptomatic myomatosis initially managed with hormonal therapy toward a large uterus that, by exceeding size and weight thresholds for a minimally invasive approach, required total abdominal hysterectomy as definitive treatment.
References
Lumsden MA, Wallace EM. Clinical presentation of uterine fibroids. Baillieres Clin Obstet Gynaecol. 1998;12(2):177-95.
Parker WH. Uterine myomas: management. Fertil Steril. 2007;88(2):255-71.
Flake GP, Andersen J, Dixon D. Etiology and pathogenesis of uterine leiomyomas: a review. Environ Health Perspect. 2003;111(8):1037-54.
Schwartz SM. Epidemiology of uterine leiomyomata. Clin Obstet Gynecol. 2001;44(2):316-26.
Schwartz SM, Marshall LM, Baird DD. Epidemiologic contributions to understanding the etiology of uterine leiomyomata. Environ Health Perspect. 2000;108(Suppl 5):821-7.
Payson M, Leppert P, Segars J. Epidemiology of myomas. Obstet Gynecol Clin North Am. 2006;33(1):1-11.
Wise LA, Palmer JR, Spiegelman D, Harlow BL, Stewart EA, Adams-Campbell LL, et al. Influence of body size and body fat distribution on risk of uterine leiomyomata in U.S. black women. Epidemiology. 2005;16(3):346-54.
Faerstein E, Szklo M, Rosenshein N. Risk factors for uterine leiomyoma: a practice-based case-control study. I. African-American heritage, reproductive history, body size, and smoking. Am J Epidemiol. 2001;153(1):1-10.
Ross RK, Pike MC, Vessey MP, Bull D, Yeates D, Casagrande JT. Risk factors for uterine fibroids: reduced risk associated with oral contraceptives. Br Med J (Clin Res Ed). 1986;293(6543):359-62.
Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-7.
Bukulmez O, Doody KJ. Clinical features of myomas. Obstet Gynecol Clin North Am. 2006;33(1):69-84.
Baranov VS, Osinovskaya NS, Yarmolinskaya MI. Pathogenomics of uterine fibroids development. Int J Mol Sci. 2019;20(24):6151.
Sohn GS, Cho S, Kim YM, Cho CH, Kim MR, Lee SR, et al. Current medical treatment of uterine fibroids. Obstet Gynecol Sci. 2018;61(2):192-201.
Wouk N, Helton M. Abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2019;99(7):435-43.
Navarro A, Bariani MV, Yang Q, Al-Hendy A. Understanding the impact of uterine fibroids on human endometrium function. Front Cell Dev Biol. 2021;9:633180.
Freytag D, Günther V, Maass N, Alkatout I. Uterine fibroids and infertility. Diagnostics (Basel). 2021;11(8):1455.
Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020;149(1):3-9.
Tanos V, Berry KE, Frist M, Campo R, DeWilde RL. Prevention and management of complications in laparoscopic myomectomy. Biomed Res Int. 2018;2018:8250952.
Lewis TD, Malik M, Britten J, San Pablo AM, Catherino WH. A comprehensive review of the pharmacologic management of uterine leiomyoma. Biomed Res Int. 2018;2018:2414609.
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Copyright (c) 2025 Walvonvitis Baes Rodrigues, Zara Escobar Benítez (Autor/a)
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