Giant Uterine Leiomyoma Causing Severe Hemodynamic Instability

Abstract

Background: Uterine leiomyomas occasionally manifest as giant leiomyomas, displaying exceptional sizes within the uterus and abdominal cavity. These massive growths, although rare because of increased patient awareness, can severely distort pelvic structures and pose life-threatening complications by compressing adjacent organs. We report a case of a patient who presented with severe hemodynamic instability, cardiac arrest, and multiorgan failure caused by a giant 54.8-kg uterine leiomyoma, representing the heaviest weight ever reported in the literature in surviving patients so far.

Case: This article documents a case of a 56-year-old woman with a giant uterine leiomyoma in critical condition characterized by multiorgan failure and acute kidney injury necessitating urgent surgical intervention. A laparotomy and subsequent total abdominal hysterectomy were performed. Histopathologic examination revealed a giant uterine leiomyoma. Postoperatively, the patient underwent intensive care management followed by rehabilitation, exhibiting significant clinical recovery.

Conclusion: Managing giant uterine leiomyomas demands a multidisciplinary approach, emphasizing tailored treatment strategies and specialized surgical expertise. The case report describes one of the largest leiomyomas in the literature, underscoring its rarity, and highlights the significance of timely diagnosis and appropriate interventions.

Fig. 1.. Preoperative situation of the massively distended abdomen with dilated veins. The patient was placed in the lateral recumbent position to prevent circulatory failure caused by intraabdominal pressure on the great abdominal vessels.

Fig. 2.. Intraoperative finding of the giant leiomyoma after the midline laparotomy was performed.

Fig. 3.. Operative field after the tumor was lifted over the symphysis pubis revealing the broad pedunculation to the uterine fundus.

Fig. 4.. Pathologic macroscopic image of the uterine leiomyoma after slicing.

Fig. 5.. Histopathologic evaluation with hematoxylin-eosin stain revealing a benign uterine leiomyoma (original magnification left ×40, right ×200).

Fig. 6.. Immunohistochemistry revealing strong positivity for actin (actin stain, original magnification ×100).