Image of the Month| Volume 43, ISSUE 10, P1123, October 2021

Parasitic Leiomyoma Involving the External Iliac Vessels

      Key Words

      A 35-year-old nulligravid woman with no prior surgeries presented with abdominal distension, bulk symptoms, and a uterus measuring 24 weeks. Magnetic resonance imaging (MRI) identified a multifibroid uterus and pedunculated fibroid measuring 13 × 8 × 15 cm. The patient deferred surgery for 1 year, citing personal reasons. Repeat MRI indicated the fibroid had grown to 20.5 cm in maximal dimension. Leiomyosarcoma could not be excluded. Gynaecologic oncology was consulted and the surgeon believed the mass to be benign. The patient consented to midline laparotomy and abdominal myomectomy.
      Intraoperative findings revealed a large vascular pelvic mass within the left broad ligament, separate from the uterus. Retroperitoneal dissection was performed including complete ureterolysis and skeletonization of the iliac vessels [Figure]. The mass appeared adherent to the rectus abdominus muscles and external iliac vessels. The sarcoma team was consulted intraoperatively to mobilize the mass off of the external iliac vessels and complete the resection. Pathology was reported as hydropic leiomyoma, likely detached or parasitic in nature. The patient's postoperative course was uncomplicated.
      Consent: Consent to publish this image was obtained from the patient.

      Linked Article

      • Léiomyomes parasites touchant les vaisseaux iliaques externes
        Journal of Obstetrics and Gynaecology Canada Vol. 43Issue 10
        • Preview
          Une femme nulligeste de 35 ans n'ayant subi aucune intervention chirurgicale antérieure s'est présentée avec une distension abdominale, des symptômes liés au volume des fibromes et pour une mesure de la hauteur utérine à 24 semaines. L'imagerie par résonance magnétique (IRM) a indiqué de multiples fibromes utérins ainsi qu'un fibrome pédiculé mesurant 13 cm × 8 cm × 15 cm. La patiente a reporté l'intervention pendant un an pour des raisons personnelles. Une IRM supplémentaire a indiqué que le volume du fibrome avait augmenté jusqu’à atteindre une dimension maximale de 20,5 cm.
        • Full-Text
        • PDF