GIANT UTERINE MYOMA AND OVARIAN MYOMA - ASSOCIATION OF TWO RARE ENTITIES. CASE REPORT AND LITERATURE REVIEW

Abstract

Uterine myomas are the most common benign tumors of female reproductive system. They affect 25% of women of reproductive age. Giant uterine myomas are quite rare and are a challenge both for a complete diagnosis and for surgical management. Extra-uterine myomas are rare and they usually appear in the genitourinary tract (ovaries, vulva, broad ligament, round ligament, urethra). Primary ovarian leiomyoma is one of the rarest solid tumors of the ovary accounting for 0.5%–1% of all benign ovarian neoplasms. We report a 45-years-old nulliparous woman who came with abdominal distension and fatigue for several months. Abdominal-pelvic ultrasound and computer tomography showed a large myoma-like mass that filled the pelvis and abdomen. The diagnosis of giant uterine myoma was established and after careful discussion with the patient total hysterectomy was proposed. Surgery confirmed the diagnosis of a giant uterine myoma with several parasitic omental blood supplies. An additional ovarian myoma was discovered and total hysterectomy with right adnexectomy was performed. Our case stresses several clinical points that should be kept in mind before planning a surgery for a giant myoma - the possible presence of parasitic blood vessels and adherences which can pose some difficulties for the surgical team and the coexistence of different pathologies masked under the size of the tumor. It is important before planning a surgery to discuss with the patient the possibility to adapt the surgery according to associated pathology.