Uterine leiomyoma - carneous degeneration

Case contributed by Dr Yair Glick

Presentation

Brisk, painful menstrual bleeding for 2 weeks.

Patient Data

Age: 14 years
Gender: Female

Right ovary measures 41 x 31 mm with small follicles. Left ovary measures 37 x 19 mm with small follicles.

Anterior uterus measures 113 x 83 x 99 mm (length x thickness x width). Mucosa deviates to the right cornu, 4 mm in thickness. On the left side of the uterus, near the floor, there is a spherical, heterogeneous structure measuring 70 mm in diameter, without internal flow - suspicious for a hematoma.

Uterine mass on the left deforming the uterus. The uterus is anteverted-anteflexed and is shifted to the right by the mass. The uterus measures 10.9 x 8.5 x 10.1 cm. The endometrial cavity is deformed with splaying into two extensions; the right extension displays a 6-mm thick endometrium and a 6-mm thick junctional zone and the left extension is compressed by the mass. The mass itself is oval, measures approximately 8 cm in its largest dimension, exhibits a heterogeneous signal and internal blood products and does not enhance. The cervix and vagina appear normal.

The ovaries are of normal size, structure and location, and contain many follicles.

The kidneys normal size, structure and location. The urinary bladder is filled partially, without any gross pathology. Small amount of free intraperitoneal fluid.

Impression

Findings are in keeping with carneous degeneration of leiomyoma.

Case Discussion

Further clinical information of a healthy girl with normal development. Menarche 2 years ago, since then menstrual cycle every 2 months with menstruation lasting 7-9 days. Brisk and painful menstrual bleeding for past 2 weeks. No drastic change in lifestyle or stress lately.

Ultrasonography and MRI showed a large intrauterine mass suspected as a degenerated leiomyoma.

Laparoscopy was performed and found a fundic uterine mass of approximately 8 cm in diameter having the appearance of an intramural leiomyoma. Adnexa of normal appearance. During hysteroscopy, an incision on the surface of the mass revealed muscle fibers and the appearance of a leiomyoma. A sample was removed and sent for histological examination.

Histology
Hysteroscopic biopsy - a fragment of necrotic degenerated tissue with scattered inflammatory cells.

A uterine leiomyoma at this girl's age is most unusual, let alone a degenerated leiomyoma.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.