Abdominopelvic leiomyoma with large ascites: A case report and review of the literature

Abstract

Background: Leiomyoma of the uterus is relatively common, but uterine leiomyoma of the greater omentum is rare.

Case summary: Here, we report the case of a 22-year-old woman who presented with a 3 mo history of progressive abdominal distension and a hypervascular abdominopelvic mass. Due to a high serum concentration of CA125, the preoperative diagnosis was unclear. During surgery, 5 L of ascites was removed. An 18.8 cm solid mass, which was pedunculated from the uterine fundus and exhibited complex adhesion to the greater omentum, was removed. The CA125 level was reduced postoperatively, and a pathologic study confirmed that the mass was a leiomyoma that originated in the uterus.

Conclusion: Uterine leiomyoma can share vessels with the greater omentum. This case highlights the difficulty of diagnosing pseudo-Meigs syndrome and the importance of imaging and laboratory examinations.

Keywords: Ascites; CA125; Case report; Greater omentum; Leiomyoma; Pseudo-Meigs syndrome.

Figure 1

Enhanced computed tomography of the abdomen/pelvis showing a large preperitoneal mass joined to the uterus.

Figure 2

Computed tomography angiography showing an abundant blood supply surrounding the mass. CIA: Common iliac artery; EIA: External iliac artery; GDA: Gastroduodenal artery; IIA: Internal iliac artery; IMA: Inferior mesenteric artery; SA: Splenic artery; SMA: Superior mesenteric artery; UA: Uterine artery.

Figure 3

Intraoperative findings. A: Bladder with a dense adhesion and the mass, which extended 3 cm below the umbilicus; B: Engorged vessels of the omentum majus that appeared along the surface of the mass; C: Lifted and turned mass showing a pedicle attached to the uterine fundus; D: Resected mass along with its pedicle stump.

Figure 4

Representative immunohistochemical images of the leiomyoma. A: H&E staining; B: Ki67 staining; C: Estrogen receptor staining; D: Progesterone receptor staining. Scale bar: 50 μm.