Cystic endometriosis in a degenerated sub-serous myoma in a sub-fertile woman: A case report

Abstract

Introduction and importance

Leiomyoma is the most common gynecologic tumor which may show atypical locations and degenerations. Cystic degeneration is said to be found in 4 % of all degenerations. Endometriosis, the presence of endometrial glands and stroma at extrauterine sites, is a common gynaecological condition seen in 10 % to 15 % of reproductive-age women usually being associated with various degrees of fertility problems.

Case presentation

40 years old woman with P1L1A2, with secondary sub-fertility for 5 years, presented with chief complaints of dysmenorrhoea for 1 year initially around the menstrual cycle relieving with analgesics but later not limited to the menstrual cycle and pain not relieving with analgesics since 1 month. The patient underwent fertility-sparing laparoscopic removal avoiding a laparotomy and definitive hysterectomy. Manual morcellation was achieved.

Clinical discussion

Cystic degeneration is rare in Leiomyoma although it is the more common gynaecological tumor in women and is associated with endometriosis probably due to retrograde menstruation.

Conclusions

Laparoscopic removal of leiomyoma without laparotomy and definitive hysterectomy for a case of cystic endometriosis in a degenerated subserous myoma which to the best of our knowledge according to our search of articles on the relevant topic is the first reported case pertaining to the topic from Nepal.

Highlights

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  Leiomyoma, being the most common gynecological tumor seen in women, is classified as sub-mucosal, intramural, and sub-serosal according to its origin with the symptoms and signs differing according to the location

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  Leiomyoma degenerations, mostly symptomatic, can sometimes be asymptomatic while subserous leiomyomas are pedunculated and symptoms can be seen due to torsion of the myoma pedicle.

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  The most common degeneration is hyaline degeneration, accounting for about 60% of all degenerating fibroids. Other types of degeneration are myxoid, cystic, calcific, mucoid, red, and fatty degeneration.

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  Cystic degeneration in leiomyoma is rare but is possible.

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  Fertility-sparing laparoscopic removal of tumors avoiding laparotomy also can provide a good outcome in recent years.