Presentation
Progressive abdominal distension, weight loss, urinary incontinence, constipation.
Patient Data
A large complex solid cystic mass was seen arising from the pelvis and extending into the abdomen. 2 differentials were considered most likely:
1. primary ovarian neoplastic lesion: appeared to arise from the right adnexa and the right ovary is not seen separately.
2. lesion arising from degeneration or neoplasia of the broad ligament fibroid: the ovarian vein was not seen to be enlarged, the uterus appeared to possibly infiltrate the right lateral uterine wall, and prior ultrasound performed 4 years prior (see below) showed a pedunculated/broad ligament fibroid that is not seen separately on the current scan.
A discrete smaller cystic lesion was seen along the left posterolateral surface of the lesion.
There were a few prominent para-aortic lymph nodes of uncertain clinical significance but no definite metastatic disease in the abdominal cavity.
A complex solid cystic mass lesion was seen arising from the pelvis and displacing the uterus to the left. The right ovary was difficult to define separately from this lesion. The previously seen likely pedunculated fibroid arising from the right side of the uterus was not reliably identified.
Arising from the superior aspect of the mass in the LUQ there was an anechoic unilocular smooth walled cyst.
A large pedunculated fibroid was seen within the right adnexa. It was poorly delineated from the right ovary and therefore was considered difficult to exclude ovarian involvement with certainty.
Case Discussion
Surgery: The patient received urgent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histology was sent.
Histopathology:
Cervix, right pelvic sidewall, endometrium and left fallopian tube were within normal limits.
The large mass arising from the uterus demonstrated features of benign leiomyoma with hydropic features.
Final diagnosis: Benign leiomyoma with hydropic features.
Discussion: This case demonstrates an unusual presentation of a fibroid. It was very large and showed cystic features. Hydropic features on microscopy are very rare with scant correlative imaging features described in the literature.
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