UTERINE MYOMA WITH CYSTIC DEGENERATION MIMICKING OVARIAN NEOPLASM: A CASE REPORT

Abstract

Objective: Myomas are the most common uterine neoplasms. They usually have a characteristic appearance on ultrasound but the myomas that have undergone degeneration may have variable patterns. We are presenting a patient with the histologic diagnosis of uterine myoma with cystic degeneration, but preoperatively, we strongly suspected that the tumor was a primary ovarian tumor. Case report: A 41-year-old woman, presented with a history of abdominal distention and pelvic pain. Abdominal sonogram showed a large, complex and predominantly cystic mass, approximately 20 cm x 30 cm in size, occupying the whole abdomen and suggestive of a suspicious ovarian neoplasm. Magnetic Resonance Imaging scan showed a large, thin-walled and predominantly cystic mass. The tumor was in general cystic but solid components showed contrast enhancement after contrast injection. Tumor markers were slightly elevated. Primary ovarian tumor was the most likely diagnosis, because of its size, cystic nature and thin walls. At laparotomy, we found an enlarged, complex and predominantly cystic tumor arising from the uterus that filled the entire abdominal cavity. Total hysterectomy and bilateral salpingectomy was done. Frozen section diagnosis was degenerated uterine myoma. Postoperative period was uneventful and the patient was discharged 5 days after the operation. The final histologic diagnosis was uterine myoma with cystic and myxoid degeneration, no mitosis nor necrosis was present. Conclusion: An uterine myoma with extensive cystic degeneration may mimic an ovarian tumor on imaging modalities and should be considered in the differential diagnosis of an adnexial / pelvic mass.