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Spontaneous expulsion of uteri leiomyoma

Pavlovskaya E.A., Trufanov G.E., Vasilchenko M.V., Peremyshlenko A.S.

 

 

Purpose. Uterine fibroid expulsion is usually described after uterine artery embolization (UAE) and considered to be complication of this angiographic procedure (1,2). UAE is applied worldwide for uterine fibroid treatment as it is safe and highly effective. Many randomized trials were performed and fibroid expulsion after UAE (3,4). The spontaneous necrosis of the leiomyoma and it’s expulsion is rare. There are some described cases in foreign literature (5-8), but we did not find cases of spontaneous expulsion described by Russian authors. That makes each described case valuable. We present a case of spontaneous expulsion in women with inflammatory changes of the ovaries with the prominent clinical symptoms. Materials and methods. The 47 y.o. female was hospitalized on emergency in the surgical department with intense pain syndrome in the lower third of the abdomen, stool and gas retention for 4 days. The patient explained that she had moderate pain in the lower abdomen for several years, but did not visit physician. She had one pregnancy with natural labor in 1994. On clinical examination: patient was hyperstenic (BMI 30), has pale skin, body temperature was 37,2C, blood pressure120/80. The abdomen was enlarged, with tympanitis, highly painful to palpation in iliac region on both sides. On speculum examination: huge pathological neoplasm with bleedings and ulcerations in vagina. In blood sample: leu-kocytosis and anemia. US was impossible to perform because of the pain syndrome. Prelim-inary diagnosis was cancer of the uterus with bowel infiltration. To assess the spread of the pathological process, the patient was sent to MRI examination. MRI was performed on 1.5 T Siemens machine with body array in the typical position (on back). The protocol included T1, T2-WI, DWI (b=1000) and contrast enhancement (Gadovist 10,0). T2-WI were performed in 3 standard planes with the big FOV (to evaluate middle part of the abdomen) and also in the axes of the uterus. Results. On T2-WI the abdomen is filled with large cysts (one over the uter-us:13,0x9,0x9,6 cm, others to the right (11x10x5,0 cm) and to the left (6,0x5,0x7,0 cm) of corpus uteri). The cystic walls were irregular, thick and retained contrast agent (pic.1b). The content of the cysts was isohyperintence on T1-WI – inflammatory cysts, most likely of the ovaries. The uterus was enlarged (13,0x6,0x6,0 cm) and distorted with the neoplasm in it’s cavity, protruding to the vagina. The contour of the lesion was even with no signs of invasion. Oblique images planned on the long axis of the corpus uteri showed a wide peduncle, connecting the lesion with the myometrium of the uterus fundus. The structure of the lesion was irregular with multiple hyperintence on T1-WI bleedings and depositions of mucopoly-saccharides (isohyperintence on T1-WI) and hyperintence liquid inclusions on T2-WI - zones of necrosis. On images with contrast enhancement all these zones were hypointence. The enlarges uterus compressed the sigmoid, that lead to bowel obstruction and clinical symp-toms. The diagnosis of the myxoid leiomyoma expulsion with inflammatory cysts of the ovaries was put. The women received a radical surgery (hysterectomy, ovaryectomy), complex anti-inflammatory treatment and discharged in 10 day after the surgery. Pathological examination proved MRI data. The diagnosis of the leiomyoma is usually not a difficult one. The typical signal char-acteristics (hypointence towards myometrium on T2-WI) and structure, round form and even contours with pseudocapsule is a key to the diagnosis. In cases of the degenerated lesion, especially in the distorted organ the diagnostics may become a challenge. The important dif-ferential in case of myxoid leiomyoma is leiomyosarcoma. Conclusion. This case illustrates the advantage of MRI over US in the means of space resolution and visualization in the situation of distorted anatomy. The correct treatment tactics was based on correct choice of visualization method for diagnostics.
1 - Almazov National Medical Research Center. 2 - S.M. Kirov’s Medical Military Academy. Saint-Petersburg, Russia.

 

 

 

 

 

 

 

 

 

 

 

 

 

Keywords:uterine fibroid, spontaneous expulsion, uterine artery embolization, uterine fibroid embolization, MRI.

 

 

 

Corresponding author:: Pavlovskaya E., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation:Pavlovskaya E.A., Trufanov G.E., Vasilchenko M.V., Peremyshlenko A.S. Spontaneous expulsion of uteri leiomyoma. REJR 2018; 8(1):240-249. DOI:10.21569/2222-7415-2018-8-1-240-249.

Received: 04.12.2017 Accepted: 29.12.2017