An unusual coincidence of giant cervical leiomyoma and incidental ovarian granulosa cell tumor: A case report

Abstract

Rationale: Leiomyomas are the most common benign tumors of smooth muscle origin in women. They are most frequently found in the submucosal tissue of the uterine corpus; however, they also occur in other areas of the uterus, including the cervix. Their size usually varies between 0.5 to 1.0 cm; however, they can reach great dimensions. A strong correlation between the onset and growth of leiomyomas and estrogen levels was observed. Granulosa cell tumor (GCT) is an infrequent sex cord-stromal ovarian neoplasm. Despite their malignancy, GCTs have a good long-term prognosis. In this study, we present a unique case of coincidence of 2 tumors: leiomyoma of rare location (cervix uteri) and extraordinary size (9, 04 cm diameter) with an adult granulosa cell tumor.

Patient concerns: A 67-year-old Caucasian woman was transported from an emergency ward to a gynecological surgery department due to a massive vaginal hemorrhage.

Diagnoses: Preliminary examination showed a presence of an enormous uteri cervix tumor.

Interventions: Initially, the patient underwent physical and ultrasound examinations. To prevent further bleeding, an urgent surgery (hysterectomy) with bilateral salpingo-oophorectomy was performed.

Outcome: Postoperative histopathological examination revealed a cervical leiomyoma and the incidental occurrence of an adult GCT in the right ovary.

Lessons: This case shares an interesting coincidence between a rare variant of leiomyoma and GCT. The study suggests that the potential reason for this can be estrogen secreted by the GCT, which causes the enormous size of the patient's cervical leiomyoma and the severe vaginal bleeding. Therefore, we advise it is important in abnormal cases to search for other hidden explanations, as in cases of GCT.

Figure 1.

Ultrasonography examination images. (A) Cervical tumor (obtained dimensions - 9.04 cm × 7.81 cm). Intravaginal examination was performed using a Wideband Microconvex Endocavitary Probe (GE Healthcare). (B). The corpus uteri presented with normal dimensions and echogenicity. Peri-abdomen examination was performed using a Wideband Convex Probe (GE Healthcare). Ultrasonography imaging was performed using the Voluson P6 Performance System (GE Healthcare).

Figure 2.

Intra-surgery images: (A) post-excision macroscopic image. (B) Intraoperation image of the tumor during its removal. In the right part of picture A, a surgical scalpel and 20 mL volume syringe is presented to illustrate the dimensions of the removed cervix tumor.