Emergency Surgical Treatment of a Large Pedunculated Subserosal Uterine Leiomyoma With Torsion: A Rare Cause of Acute Abdomen.

Torsion of pedunculated subserosal leiomyoma of the uterus is a rare cause of acute abdomen. A 27-year-old female patient with twisted subserosal pedunculated uterine leiomyoma misdiagnosed as an adnexal mass underwent laparotomy. The patient came to the Emergency Department of General Hospital of Trikala with symptoms of acute abdomen. Primarily, clinical-laboratory examination, transabdominal ultrasound, raised the suspicion of a twisted adnexal mass. Intraoperatively, a twisted pedunculated subserosal leiomyoma of the uterus was identified and myomectomy was performed. Histological examination of the surgical specimen confirmed the diagnosis. On the third postoperative day, our patient was discharged. This paper underscores the rarity of torsion of the uterine pedunculated subserosal leiomyoma and emphasizes the necessity of urgent surgical intervention. The challenges of preoperative diagnosis are highlighted, especially when modern diagnostic imaging modalities are unavailable.

Torsion of a Pedunculated Subserosal Leiomyoma: A Rare Cause of Acute Abdominal Pain.

Uterine leiomyomas are benign uterine tumors arising from the smooth muscle cells of the myometrium. Most of them are asymptomatic, and rarely do they present with symptoms like infertility, abdominal distension, and acute abdomen. According to experts, the most common cause of acute abdomen is torsion of a pedunculated subserosal leiomyoma, which is an extremely rare and life-threatening surgical emergency. Here, we discuss a case of torsion of a subserosal leiomyoma where the patient, a 40-year-old female with severe abdominal pain, was misdiagnosed with a twisted ovarian cyst. Ultrasonography and contrast-enhanced computed tomography (CECT) revealed a right-sided ovarian tumor and a twisted subserosal myoma, respectively. Thus, surgical intervention with myomectomy was done.

Diagnostic performance of preoperative MR imaging findings for differentiation of uterine leiomyoma with intraligamentous growth from subserosal leiomyoma.

PURPOSE: To evaluate the diagnostic performance of MRI findings for differentiating uterine leiomyoma with intraligamentous growth, or broad ligament fibroid, from subserosal leiomyoma. METHODS: This study included 37 patients with surgically confirmed uterine smooth muscle tumors (36 leiomyomas and one smooth muscle tumor of uncertain malignant potential) with intraligamentous growth (IL) and size-matched control of 37 patients with subserosal leiomyoma (SS). Two radiologists independently evaluated eight preoperative MRI findings: tumor shape, degeneration, attachment to uterus, ovary elevation, ureter displacement, bladder deformation, rectal displacement, and separation of round ligament (RL) and uterine artery (UA). The diagnostic values of these findings and interobserver agreement were assessed. Receiver-operating characteristic (ROC) analysis of the number of positive MRI findings for diagnosing IL was performed. Clinical outcomes including surgical method, operation time, intraoperative blood loss, perioperative complications, and postoperative hospital stay of the two groups were compared. RESULTS: Significant differences in tumor shape, attachment to uterus, ovary elevation, ureter displacement, and separation of RL and UA were found between IL and SS. Four of these findings, excluding ureter displacement, showed moderate to substantial interobserver agreement. When two or more of these four findings were positive, sensitivity, specificity, and area under the ROC curve were 91%, 77%, 0.90 in reader 1 and 82%, 89%, 0.91 in reader 2. The operation time was significantly longer for IL than for SS. CONCLUSION: Tumor shape, attachment to uterus, ovary elevation, and separation of RL and UA are useful MRI findings for differentiating intraligamentous leiomyoma from subserosal leiomyoma.

Case of leiomyosarcoma arising from subserosal leiomyoma.

Uterine leiomyosarcoma (LMS) is a rare tumor. It has not been established if these tumors arise de novo or from pre-existing leiomyomas (LM). We report a case herein of LMS arising from a subserosal LM. A 47-year-old nulliparous woman was diagnosed with a uterine tumor measuring 30 cm in diameter by pelvic magnetic resonance imaging. Serum CA-125 level was 369 U/mL, and the lactate dehydrogenase level was elevated (565 IU/L, respectively). Positron emission tomography-computed tomography revealed abnormal uptake (SUVmax = 25.29) of the abdominal tumor. Upon laparotomy, a large tumor with solid and cystic components was shown to arise from a subserosal LM, with invasion into the greater omentum and small intestine. Abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and small intestine resection were performed. Macroscopic findings showed that the LMS was adherent to a subserosal LM, without continuity between the tumor and the uterus. Our case supports the hypothesis that LMS can arise from a pre-existing LM.

Spontaneous parasitic leiomyoma in a post-partum woman.

We report a case of spontaneous parasitic leiomyoma in a 30-year-old post-partum woman. A subserosal leiomyoma had been noted at the first trimester screening, and she had experienced persistent abdominal pain during her previous pregnancy. She was referred to hospital with severe abdominal pain at 7 months after delivery. We detected a homogenous solid tumor that resembled the subserosal leiomyoma but was completely detached from the uterus. On laparoscopy the vascularization of the tumor was supplied from the omentum, which was tightly adherent to the tumor. Histopathologically, the tumor was surrounded by a fibrous vascular capsule, and broadly hyalinized and partially calcified, consistent with a degenerated uterine leiomyoma. Detachment of a pedunculated subserosal leiomyoma from the uterus following adhesion to other pelvic structures throughout pregnancy may result in a parasitic leiomyoma, a rare subtype of uterine leiomyoma.

Two cases of torsion of subserosal leiomyoma and literature review / 대한산부인과내시경학회지

Leiomyoma is the most common benign uterine tumor, but acute torsion of myoma is extremely rare. We experienced two patients admitted to our hospital for acute abdominal pain, who diagnosed with torsion of subserosal myoma. Although ultrasonogram revealed a subserosal myoma in both cases, it could not confirm torsion of uterine fibroid. Laparoscopic surgery confirmed the diagnosis of acute torsion of myoma and resected the lesion successfully.