INTRODUCTION:

A leiomyoma with rare degenerative changes is a diagnostic challenge difficult to differentiate from its malignant counterparts, if it is intended to be based only on imaging findings.

CLINICAL CASE:

40-year-old female patient referred to the Minimally Invasive Surgery service in March 2021 due to increased abdominal perimeter, decreased appetite and dyspnea on medium exertion. Abdomino-pelvic ultrasound reported that the uterus was enlarged, with medium-element intramural fibroids. The endometrium was heterogeneous. The right ovary had a complex, giant cyst, 276 mm x 250 mm x 276 mm, with a volume of 10,000 cc. In addition, splenomegaly, right hydronephrosis and left renal lithiasis. Tumor markers were reported normal. Laparoscopic surgery showed a tumor occupying the entire abdominal cavity measuring 40 x 30 cm and attached to the posterior wall of the uterus, with both ovaries unaltered, with no free fluid; total hysterectomy was performed.

CONCLUSIONS:

Degenerative changes in uterine leiomyomas can distort the usual tumor structure and reflect it in images typical of an ovarian cystic tumor; in the initial study this represents a challenge for the surgeon and should be considered part of the differential diagnosis of adnexal masses. In the case patient, with minimally invasive surgery, complete resection of the specimen was achieved, despite the increased size, with less risk of wound complications and less postoperative pain; the incisions are small and with favorable esthetic outcomes and fewer days of in-hospital stay.

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