Authored by Sofoudis Chrisostomos*
Abstract
Leiomyomas represent the most common type of benign tumours of the female genital tract. Assiduous preoperative imaging findings reflect proper therapeutic mapping. In cases of female patients of reproductive age, the ultimate goal remains the fertility preservation and the quality of life of the patient.
According to recent bibliography, bizarre leiomyomas remain a controversial issue regarding the preoperative and postoperative therapeutic mapping. Giant cells with pleomorphic nuclei and little or no mitotic activity compose the microscopic analysis of such lesions.
Multidisciplinary approach is mandatory in order to establish ultimate diagnosis and treatment. Bizarre leiomyomas still represent a gray scale among the whole scientific community.
Keywords: Bizarre myomas; Laparoscopic dissection; Mirror depiction
Introduction
Incidence of uterine fibroid tumours increases as women grow older, and they may occur in more than 30% of women 40-60 years of age [1].
Risk factors include null parity, obesity, family history, black race, and hypertension [2]. Uterine fibroids consist of smooth muscular tissue with always the possibility of malignant transformation.
Tumour size and anatomic location are strongly accompanied with assiduous therapeutic strategy. Therapeutic strategy is strongly accompanied with age and fertility capacity of the patient.
In cases of degenerated uterine fibroids in nulliparous patients, laparoscopic approach represents the gold standard of surgical confrontation. Focusing on current bibliography, classification of uterine myomas is mandatory in order to establish proper diagnosis and treatment.
Classification of uterine fibroids consists intramural, subserosal, sub mucosal and intraligamentary (inside parametrial area) [3].
Ultimate goal remains, especially in nulliparous women, extremely conservative approach, protection of fertility preservation and increase patient’s quality of life.
Objective of our study reflects thorough diagnosis and assiduous treatment of clinical symptomatic and ultra-sonographic mirror depiction of two enormous intramural myomas.
Case
We present a case of a 38-year old patient (G0, P0) admitted at our Department, complaining of severe episodes of menorrhagia followed by diffuse abdominal pain.
Analysing her atomic history, she reported reception of thyroxin agents, due to her history of hypothyroidism. Undergoing of cervical cryotherapy due to infiltration of HPV (Human papilloma virus). Transvaginal ultra-sonographic evaluation depicted presence of two enormous intramural myomas maximal diameter around 7cm (Figure 1).
Abdominal MRI confirmed all imaging findings, consisting of conservative therapeutic mapping, focusing always on fertility preservation. Patient underwent laparoscopic dissection of intramural myomas, as standard of care towards the establishment of proper therapeutic strategy.
Preoperative injection of pitressin in order to decrease any intraoperative myometrial bleeding (Figure 2). Penetrating the abdominal cavity two enormous intramural myomas mirror shaped was performed. Same maximal diameter, origin and depth of infiltration.
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