Atypical leiomyoma: unusual locations and findings coupled with uncommon presentation

Extrauterine leiomyomas are a rare phenomenon, and they present a great diagnostic challenge. Retroperitoneal leiomyomas remain asymptomatic for a variable period and usually present with wide variety of signs and symptoms. A 51 years old female was multiparous and had undergone a total laparoscopic hysterectomy along with a bilateral salpingo-oophorectomy about four years ago. She visited the outpatient department of a tertiary care hospital complaining of something coming out per vaginum and expressed difficulty in passing urine and also complained of stress urinary incontinence. Bimanual pelvic examination, ultrasonography (USG) and Magnetic resonance imaging (MRI) revealed a large oval shaped well defined solid mass completely filling the vaginal canal while compressing urinary bladder. Tumor marker levels were normal. Laparotomy with adhesiolysis and complete excision of retroperitoneal mass was performed. Frozen section followed by histopathology and immunohistochemistry confirmed that the mass was a leiomyoma. After surgical intervention and removal of mass, the symptoms dissipated and patient had a complete recovery. Despite hysterectomy the manifestation of leiomyoma appears to be apparent. Surgical excision of the mass appeared to be the correct move forward after the leiomyoma was diagnosed with the help of the MRI and the USG

A Case of a Retroperitoneal Leiomyoma during Total Laparoscopic Hysterectomy

Retroperitoneal leiomyomas are rare clinical entities and poses clinical and therapeutic challenges to the benign gynecologist. We present the case of a 51 year-old gravida 2 para 2 with symptomatic leiomyomas undergoing definitive surgical management with total laparoscopic hysterectomy. Intraoperatively, a retroperitoneal mass in the pelvic side was identified, excised, and removed from the abdominal cavity without complications. Final pathology confirmed a leiomyoma

Iatrogenic parasitic myomas following uterus removal: a preventable entity

Increasing trend of iatrogenic parasitic myomas has compelled us to review about preventive measures to tackle this menace. We are sharing our experience of two unique cases of parasitic myomas. Even though it is not completely preventable, strategic steps will definitely reduce the incidence and severity. With increased magnification and access to the entire abdominopelvic cavity, a laparoscopic view may be more beneficial for diagnosis of unknown or unsuspected masses as well as prevention

Extra-Uterine Fibroids

Leiomyomas are the most common gynecologic and uterine neoplasms. Uterine leiomyomas present in approximately 25% of women during reproductive age. Extrauterine leiomyomas (EULs) are rarer and usually arise in the genitourinary tract, however, may arise at nearly any anatomic location and possess a great diagnostic challenge. Moreover, the EULs may also present with unusual growth patterns such as disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, benign metastasizing leiomyoma, parasitic leiomyoma, and retroperitoneal mass. However, the cell of origin from smooth muscle cells and histological benign characteristics is similar to their uterine counterpart. The presence of a synchronous uterine leiomyoma or history of previous hysterectomy is a considerable evidence for the diagnosis of these abnormally located and unusual growth pattern displaying EULs. Different imaging modalities like ultrasonography, computed tomography, and magnetic resonance imaging are helpful in the diagnosis of EULs, however, sometimes a histopathological examination is required for the confirmation

Lateral coagulation of the uterine artery at its origin prior to total laparoscopic hysterectomy. A randomized control trial

Background and Objectives: Lateral occlusion prior to TLH has been suggested to reduce perioperative bleeding, operative time, and hospital stay. Furthermore, reducing the amount of bleeding and the length of the operation may affect parameters such as postoperative pain and the number of patients with postoperative vaginal vault hematoma. Methods: This RCT was conducted at a single center at Odense University Hospital in Denmark. Between February 2016 and February 2019, a total of 58 patients undergoing TLH and bilateral salpingectomy for benign cases were recruited to the study. Results: The mean operating time was significantly longer in the LA group with a mean difference between the two groups of six minutes. No other discrepancy regarding the primary outcomes was observed between the two groups. Total blood loss was similar in the two groups as well as the average hospital stay and the VAS score during the first seven days. 93% of the patients were discharged from the hospital within the first 24 h postoperatively. Conclusion: This RCT demonstrates that lateral occlusion of the uterine artery prior to TLH does not improve outcome for the patients and should therefore not be used as a standard procedure.</p

Giant uterine leiomyoma: a case report with literature review

Uterine leiomyomas are one of the most common entities encountered in routine gynaecological practice; however, the giant uterine myomas are very rare and can often create a diagnostic dilemma and therapeutic challenge owing to their size, non-specific clinical presentation and degenerations. Here, in this article we review the literature on giant uterine leiomyomas and report one such case in a 38-year-old woman who presented with the complaints of vague abdominal lump, enlargement of abdomen, dysmenorrhea, lower abdominal and pelvic pain since last 2 years and a 6-month history of increased frequency of micturation. Physical examination and radiological investigations suggested a giant abdominopelvic mass, probably a uterine or an ovarian malignancy. An exploratory laparotomy was performed followed by total hysterectomy. Grossly, the specimen was a 15.2 kg uterine leiomyoma measuring 18x18x13 cm in size. Histologically, the benign leiomyoma showed cystic degeneration. The patient’s post-operative and follow-up period was uneventful

A five-year retrospective study of cervical fibroids in a tertiary care centre

Background: Cervical leiomyomas or fibroids are rare benign pelvic tumors. The symptoms vary from urinary retention, frequency, dyspareunia, intermenstrual bleeding, rarely mimicking procidentia or can cause uterine inversion. This study was conducted in a tertiary hospital to find out clinical presentation, prevalence of cervical fibroids.Methods: This study is a retrospective study where Women ranging from 20 to >60 years age attending gynecology OPD of Cheluvamba hospital tertiary care centre attached Mysuru medical college and research centre, Mysuru for abdominopelvic mass, pain, menstrual abnormalities over a period of 5 years (January 2012 to December 2016) were included the study. Socio-demographic profile, detailed menstrual history, reason for attending hospital and previous treatment taken prior to the hospital visit were recorded. Pregnant women with fibroids were excluded from the study. Parameters like type and size of cervical fibroid, mode of treatment, postoperative morbidities, histopathological reports were studied and interpreted in this study.Results: In this study total 20 women who presented with menorrhagia or with abdominopelvic mass had cervical fibroid. Of 20 patients 10 (50%) belonged to age group 31-40 years, 9 (45%) patients were of 41-50years age and 1 (5%) patient was >60 years age. The 16 (80%) patients presented with menorrhagia. Metrorrhagia was the commonest menstrual pattern seen in 15 (75%) women. Asymptomatic fibroids with abdominopelvic mass were seen in 4 (20%) women. The size was 12-28 weeks. Polypectomy was done in 1 (5%) woman and abdominal hysterectomy was done in 19 (95%) women. None of the patient had postoperative morbidity or mortality. histopathological reports in 17(85%) showed leiomyoma without degeneration while 3 (15%) cases showed degenerative changes.Conclusions: Further research is needed to find out biological factors causing fibroids including diet, stress, environmental and racial influences. Routine screening, early detection, increase awareness by early reporting to the hospital will reduces morbidity and improves quality of life socioeconomically

Assessment of the learning curve: total laparoscopic hysterectomy versus total abdominal hysterectomy

Background: Abdominal hysterectomy is the most frequented way of hysterectomy in the world; today we have a lot of techniques for hysterectomy. Total Laparoscopic Hysterectomy (TLH) versus Total Abdominal Hysterectomy (TAH) needs experience an assessment of the learning curve. Objective of the study was to determine the feasibility and safety of TLH and TAH.Methods: Total 100 women were taken for study. Operating time, estimated blood loss, operating complication and length of stay in hospital were noted for each patient. The success rates of TLH were more compared to TAH. The operating time estimated blood loss, conversion to laparotomy was directly proportional to size of uterus.Results: There were no statistically significant differences between the two groups regarding age, body mass index (BMI), specimen weight, pre-operative hemoglobin (Hb) value and rates of the complications. The mean post-operative Hb value was significantly higher in group TLH than group TAH (11.3±0.7 gr/dl versus 10.6±1.6, p = 0.03). The mean time of operation was significantly longer in TLH than group TAH (105.4±22.9 minutes versus 74±18, p&lt;0.001). The mean duration of hospital stay was statistically shorter in TLH compared to the TAH (2.47±0.5 days versus 4.86±1.1, p&lt;0.001).Conclusions: Advantage of TLH over TAH are less blood loss, fewer wound infection and fever, smaller incisions, with less pain, shorter hospitalization time, speedier recovery