A sizeable fibromatous uterus discovered incidentally in an asymptomatic woman

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Uterine leiomyomas are the most frequent benign pelvic tumors in females. These tumors appear in almost half of women over 35 and may produce pelvic pain, bleeding, infertility, and adjoining organs abnormal pressure [1]. We present a rare case of a 50-year-old caucasian woman whose uterine tumors grew silently until suspected by her general physician at a regular visit. She consulted a physician sporadically, without a thorough physical examination, leaving the numerous and large fibroids undiagnosed and untreated.

The gynecological exam revealed a large mass that arose from her pelvis up to the mid-distance between the umbilical scar and xiphisternum. On vaginal examination, the cervix was certified with difficulty, as it was displaced and situated in close vicinity with pubic arch due to the large fibroids developed posteriorly. The computed tomography scan revealed a large tumor that involved the abdominopelvic cavity entirely (Figures 1, 2, and 3). The mass measured 25 × 20 × 15 cm and was not separated from the uterine cavity.

The abdomen was opened with a midline longitudinal incision from the pubic symphysis to 3 cm above the umbilical scar. A large, firm, multilocular mass (Figure 4) was observed from the uterus with the upper limit close to the xiphisternum. Two large myomas developed posteriorly and significantly modified the normal anatomy. A total abdominal hysterectomy en bloc with bilateral adnexectomy was performed, with a rapid postoperative recovery.

Large fibroids may appear as a surprising diagnostic and can be managed after proper diagnosis and surgical expertise