Presentation
Abdominal mass.
Patient Data
FINDINGS
The uterus is markedly enlarged and contains multiple fibroids as follows:
Large intramural fibroid in the body
Large right pedunculated fibroid extending into the right upper quadrant
Pedunculated right fundal fibroid
Intramural fundal fibroid
All bar the large dominant cystic fibroid in the body of the uterus enhance with gadolinium. There is no restricted diffusion in any of the lesions. The endometrial cavity is distorted.
A small amount of free fluid is present in the pelvis.
HISTOPATHOLOGY
CLINICAL HISTORY: Uterus and tubes.
MACROSCOPIC: Uterus and both tubes – a uterus distorted by multiple fibroids with one attached fallopian tube and a separately present fallopian tube. The specimen weighs 1510 grams. The attached fallopian tube is 55mm x up to 10mm and the separately present fallopian tube is 60mm x 8mm. Both fallopian tubes appear macroscopically normal. The uterus is 110mm from fundus to ectocervix, 110mm intercornual. The ectocervix is 25mm x 20mm with a round central 8mm os. The two largest subserosal fibroids are 120mm and 115mm in maximum dimension. The overlying serosal surface is smooth, intact. The endometrium is up to 3mm in thickness. Numerous intramural, submucosal and subserosal fibroids are present. One intramural fibroid shows central area of hemorrhage and one submucosal fibroid shows central soft area. The remaining fibroids are well circumscribed with firm cream, whorled cut surface and well defined borders.
MICROSCOPIC: Sections from the endometrial mucosa show an early secretory phase pattern with no polyp formation or other pathological change. Sections from the fibroids show leiomyomas. These feature bland smooth muscle cells in interlacing fascicles, focally forming coalescing nodular groups. Areas of stromal hyalinisation are seen. Sections from block G show organizing thrombus within vessels within a fibroid. Lesional mitotic figures are infrequent and there are no areas of confluent recent necrosis. Part of the fibroid is sampled in block M shows an area of degeneration, edema and hyalinisation consistent with old necrosis. Sections from the endo–and ectocervical mucosal regions show no pathological abnormality. Sections of the fallopian tubes show normal mucosal architecture, with no inflammation, hemosiderin deposition or fibrosis. There is a small paratubal benign epithelial lined cyst. There is no dysplasia.
DIAGNOSIS: Uterus: Multiple benign leiomyomas, normal cervix and normal secretory endometrium. Fallopian tubes: No significant abnormality.
Case Discussion
This case demonstrates a multi-fibroid uterus that presented as an abdominal mass. One very large fibroid extends into the right upper quadrant.
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