Unaware of a large leiomyoma: A case report with respect to unusual symptoms of large leiomyomas

INTRODUCTION: Uterine leiomyoma, which arises from uterine smooth muscle, is the most common benign gynecologic tumor of the female pelvis. Clinically, these leiomyomas are diagnosed in approximately 25% of women, the prevalence increases during reproductive age, decreases after menopause, and they are rare in adolescents. In addition to uterine leiomyoma, there are also extrauterine leiomyomas. PRESENTATION OF CASE: A 48-year-old multiparous woman visited our outpatient clinic for routine control. She had no symptoms or complaints. Her last health service visit was over 5 years ago, in which she was told that she had a small uterine leiomyoma, which did not require further management. Abdominal examination revealed a large mass extended above the umbilicus, and there was no abdominal tenderness. Abdominal ultrasonography showed a large solid mass occupying the abdomen. Routine laboratory test results were normal, except the hemoglobin level, which was 7.88 g/dl. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The final diagnosis was a 17-cm, 3985-g intramural, myomatous, cellular leiomyoma that occurred without secondary changes, necrosis, cellular atypia, or mitosis. DISCUSSION: The most common presenting symptoms of large uterine leiomyomas are abnormal bleeding, dysmenorrhea, pelvic pain, and tumor bulk-related signs. Moreover, there are unusual symptoms or clinical manifestations such as acute edema, thrombosis, ulcer, plethora, calcified pelvic masses, hematometra, severe pulmonary hypertension, and respiratory failure; hence, they can be even life threatening. CONCLUSION: Patients might have no symptoms or might be unaware of the presence of a large uterine leiomyoma, as in our case; however, large leiomyomas have various unusual symptoms in addition to the common ones. These symptoms should not be disregarded or underestimated.