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Huge subserosal uterine leiomyoma (fibroid)

Case contributed by Karwan T. Khoshnaw
Diagnosis almost certain

Presentation

Pelvic discomfort, ultrasound showed a large pelvic mass.

Patient Data

Age: 30 years
Gender: Female

Anteverted uterus, homogeneous in texture and empty cavity with evidence of a large well defined round lesion occupying the posterior aspect of the uterus and compressing the rest of the uterus anteriorly, measuring appx. 12 x 10 cm. It shows low signal intensity on T1WIs and heterogeneously hypointense on T2WIs, the findings in favor of a huge subserosal leiomyoma (fibroid).

Also, there is a small well-defined oval lesion in the mid segment of the anterior aspect, measuring appx. 13 x 8 mm, it shows low signal intensity on both T1 and T2WIs, the findings in favor of a small subserosal leiomyoma (fibroid).

Clear left adnexa.

A well-defined round shaped unilocular cystic lesion is seen in the right adnexa measuring 37 x 37 mm in maximal transverse diameter. It shows fluid signal (hypointense in T1 and high signal in T2 weighted images) and it has a thin wall with no evidence of fatty tissue, no internal septations or mural nodule could be seen, the findings in favor of a simple ovarian cyst.

Case Discussion

Uterine fibroids (leiomyomas) are common benign uterine lesions. They are usually detected incidentally but if large enough, they can present as palpable masses, a leiomyoma is often called subserosal if >50% of the fibroid protrudes out of the serosal surface of the uterus. 

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