Large uterine leiomyoma: a literature review and a clinical case report of a 16-year-old girl

Background: Uterine leiomyoma is extremely rare in adolescence (less than 1%). The reason for seeking health care in these patients is complaints of copious and painful menstruation, tensive pains in the lower abdomen, and abdominal enlargement. However, given that uterine fibroids are asymptomatic and the mass often reaches large sizes by the time of diagnosis in most cases. In the above situations, the possibility of performing organ-sparing treatment is of particular importance. Case report: The paper reviews the data available in the literature and describes a rare clinical case of large uterine fibroids in a 16-year-old girl. The patient and her parents visited a physician for complaints of copious painful menstruation and an abdominal enlargement. Pelvic magnetic resonance imaging revealed an intramural uterine fibroid measuring 123x74x121 mm (the uterus measuring 148x107x128 mm) originating from the left rib at the level of the corpus uteri. The mass substantially distorted the uterine cavity. The patient was referred to the Center for hospitalization. She received surgical treatment: laparoscopy with transition to transverse suprapubic laparotomy; myomectomy without uterotomy; and autoerythrocyte reinfusion. Morphological examination diagnosed uterine leiomyoma with edema and hyalinosis. Immunohistochemical examination of the expression of H-caldesmon confirms the smooth muscle nature of the tumor and analysis of the expression of PHH3, Ki-67, p53, and p16 indicates its low mitotic activity. The postoperative period was uncomplicated. The patient was discharged home in a satisfactory condition to be followed up by an obstetrician/gynecologist at her residence. At 2 months after surgery, control pelvic ultrasound examination showed no abnormalities. Conclusion: Despite the rare frequency of uterine fibroids in childhood, these clinical cases are encountered in the practice of an obstetrician/gynecologist. In order to early diagnose pelvic organ diseases and to perform timely organ-sparing treatment, all teenage girls are indicated to undergo routine preventive examinations, including ultrasound study.

uterine leiomyoma, teenage girls, children, benign masses, surgical treatment