Ren HM, Wang QZ, Wang JN, Hong GJ, Zhou S, Zhu JY, Li SJ. Diffuse uterine leiomyomatosis: A case report and review of literature. World J Clin Cases 2022; 10(24): 8797-8804 [PMID: 36157811 DOI: 10.12998/wjcc.v10.i24.8797]
Corresponding Author of This Article
Shan-Ji Li, Doctor, MD, Associate Chief Physician, Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 160 Pujian Road, Pudong New Area, Shanghai 200127, China. 13524459739@163.com
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hui-Min Ren, Gang-Jie Hong, Department of Gynecology, Zhoushan Branch Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Zhoushan 316000, Zhejiang Province, China
Qing-Zhu Wang, Department of Obstetrics and Gynecology, Ningbo Hangzhou Bay Hospital, Ningbo 315336, Zhejiang Province, China
Jia-Nan Wang, Department of Pathology, Zhoushan Branch Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Zhoushan 316000, Zhejiang Province, China
Shuang Zhou, Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200090, China
Jun-Yan Zhu, Shan-Ji Li, Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
Author contributions: Ren HM and Wang QZ contributed equally to this work; all authors contributed to the design and conduct of the study and approved the submission of this work for publication.
Informed consent statement: Informed consent was obtained from the patients for participation in this study and the publication of the results.
Conflict-of-interest statement: None of the authors have any conflicts of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shan-Ji Li, Doctor, MD, Associate Chief Physician, Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 160 Pujian Road, Pudong New Area, Shanghai 200127, China. 13524459739@163.com
Received: April 29, 2022 Peer-review started: April 29, 2022 First decision: May 12, 2022 Revised: May 24, 2022 Accepted: July 16, 2022 Article in press: July 16, 2022 Published online: August 26, 2022
Abstract
BACKGROUND
Diffuse uterine leiomyomatosis (DUL) is a benign uterine smooth muscle neoplasm with unknown etiology. Since DUL is rarely reported, knowledge regarding it is limited. The rate of early diagnosis is low, and DUL is often misdiagnosed as common multiple uterine leiomyomas before surgery.
CASE SUMMARY
A 27-year-old patient with no sexual activity presented to the Emergency Department of our hospital complaining of heavy vaginal bleeding. She had a history of uterine fibroids and menorrhagia. Pelvic examination showed a regularly enlarged uterus, similar in size to that associated with a 4-mo pregnancy. Pelvic magnetic resonance imaging (MRI) revealed numerous multiple uterine fibroids, and a transabdominal myomectomy (TM) was performed. Intraoperative exploration revealed that the myometrium was full of myoma nodules of variable sizes. Over 50 leiomyomas were removed. The pathology report confirmed leiomyoma. The patient was discharged and received a gonadotropin-releasing hormone analog (3.75 mg) for 6 mo. Ten months after surgery, the patient presented to the hospital again for abnormal uterine bleeding. MRI showed an irregular mass with a diameter of 5.2 cm without sharp demarcation in the uterine cavity. Submucosal leiomyoma was considered first, and the patient underwent a hysteroscopic myomectomy plus hymen repair. Intraoperative exploration showed that there were several leiomyomatosis masses in the cavity. Postoperative pathological examination confirmed submucosal leiomyoma and necrotic and generative tissue. Although the menstrual cycle was still irregular, the patient did not have symptoms of menorrhagia for a period of 28 mo after the second surgery.
CONCLUSION
Individuals with DUL are easily misdiagnosed due to the lack of specific manifestations of this disease. MRI is helpful for early identification and preoperative evaluation. There is currently no unified method of diagnosis. For women who want to preserve fertility, conservative surgery should be made an option. When TM is chosen, a modified new myomectomy should be considered to avoid the drawbacks of traditional TM.
Core Tip: Diffuse uterine leiomyomatosis (DUL) is a benign uterine smooth muscle neoplasm with unknown etiology. Hysterectomy is the only curative therapy. We report a 27-year-old female with no sexual activity who was diagnosed with DUL. The patient was misdiagnosed with leiomyoma preoperatively, followed by treatment with transabdominal myomectomy (TM), a gonadotropin-releasing hormone analog, and hysteroscopic myomectomy plus hymen repair. This case highlights the importance of pelvic magnetic resonance imaging as a diagnostic tool. For women who want to preserve fertility, conservative surgery should be an option. When TM is chosen, a modified new myomectomy should be considered to avoid the drawbacks of traditional TM.
