Rare clinical entity of huge leiomyoma uteri in a 17-year-old adolescent managed with a fertility-sparing procedure: Case report and literature review

一例罕见的17岁青少年巨大子宫肌瘤病例报告及文献综述:采用保留生育功能的手术治疗

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Abstract

INTRODUCTION AND IMPORTANCE: The most frequent benign uterine tumor is uterine fibroids. Approximately, 20 to 30 % of women between the ages of 30 and 50 have them. Teenagers do, however, rarely experience them; the prevalence is less than 1 % in general population. CASE PRESENTATION: We present a 17-year-old nulliparous female who was admitted to the hospital due to gradually increasing abdominopelvic pain. Transabdominal pelvic ultrasound showed massive uterine enlargement, with a heterogenous structure within the fundus measuring 9.8 cm in diameter. Pelvic MRI revealed an enlarged uterus with a heterogeneous complex mass measuring 10.78 cm by 8 cm that seemed to be compressing but was not attached to the endometrium The findings from the radiology review were concerning for leiomyoma. Intraoperative findings showed a 13-cm anterior intramural mass with normally appearing fallopian tubes and ovaries bilaterally. Resection of the mass was done, and the entire specimen was sent to pathology which confirmed the diagnosis of leiomyoma. DISCUSSION: Occurrence of uterine fibroids in the young and adolescent age is extremely rare with an estimated prevalence of less than 1 %. Leiomyosarcoma is a less frequent diagnosis to take into account, but it can be identified histologically. Therefore, a myomectomy that preserves fertility enables a diagnostic chance to rule out a probable cancer. CONCLUSION: When young women present with steadily worsening abdominopelvic discomfort, it is crucial to include leiomyomas in the differential diagnosis despite the rarity of leiomyomas in adolescents.

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