UTERINE FIBROID IN A 16-YEAR-OLD ADOLESCENT MANAGED WITH A FERTILITY-SPARING APPROACH: A CASE REPORT
2Gynaecology, Faculty of Additional Federal Education "Moscow State University of Medicine and Dentistry", Moscow, Russian Federation, Moscow
3Gynaecology, Russian Children's Clinical Hospital of the Federal State Autonomous Educational Institution Of Higher Education - Pirogov Russian National Research Medical University Of The Ministry Of Health Of The Russian Federation, Moscow
4Gynaecology, Federal State Autonomous Educational Institution Of Higher Education - Pirogov Russian National Research Medical University Of The Ministry Of Health Of The Russian Federation, Moscow
5Gynaecology, Morozov Municipal Pediatric Clinical Hospital of the Department of Health, Moscow
6Gynecology, Federal State Budgetary Institution N.I. Pirogov National Medical and Surgical, Moscow
A 16-year-old girl was admitted to the Gynecological Department of Children’s Hospital with complaints on abdominal pain and increasing abdominal girth. Abdominal examination revealed a soft abdomen with a voluminous, partially mobile, pelvic mass. During the rectal examination a rounded mass about 10 × 9 cm in size, motionless, sensitive when displaced.
Ultrasound of the pelvic organs revealed: a voluminous mass, displacing the uterus and the ovaries and measuring approximately 9,7x8,6x10,3 cm. Laboratory tests: complete blood count without changes, alpha-fetoprotein (AFP) - 3.18 IU / ml, human chorionic gonadotropin (hCG) - 0.1mIU / ml, CA-125 - 61.7 U / ml (reference values - 0.0—35.0 U / ml). The patient underwent MRI, which confirmed: the lesion, widely inhomogeneous, presented a large central areas inhomogeneously hypointense in the T2-weighted sequences and showed an inhomogeneous post-contrast enhancement, more evident at the periphery, and inhomogeneous restriction of diffusivity. The lower portion tightly adhered to the left portion of the uterine fundus, without a clear cleavage plan; the ovaries, located medially and characterized by the presence of multiple follicles, were not involved by the tumor.
After multidisciplinary meeting, surgical excision of the mass was indicated. Median laparotomy was performed; upon opening, the abdomen was widely occupied from the lesion, arising from the fondus of the uterus. The left and right ovaries were inspected and found to be grossly normal. No pathological lymph nodes or peritoneal implants were present. “En-bloc” resection of the mass was accomplished, but the encasement of the uterine fondus didn`t allow to preserve the entrance of the fallopian tubes. The uterine wall was then was reapproximated by double interrupted stitches in adsorbable suture.
Grossly the resected specimen measured 9,7x8,6x10,3 cm. The histological conclusion was obtained on the 5th day of the postoperative period: a morphological picture of torsion of the adnexal masses against the background of a leiomyoma. The postoperative period was uneventful, the patient was discharged home on the 6th day after surgery.
Conclusion: When young women present with steadily worsening abdominopelvic discomfort, it is crucial to include leiomyomas in the differential diagnosis despite the rarity of leiomyomas in adolescents
