Disseminated Intracavitary Leiomyomatosis: An Intraoperative Diagnosis
CANSAGE ePoster Library. Mathur S. 09/27/19; 275258; eP-125
Dr. Siddhi Mathur
Dr. Siddhi Mathur
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Abstract
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Objective: Subendothelial (intracavitary) leiomyomas are rare and can be challenging to manage. They commonly recur and present with significant abnormal uterine bleeding or infertility. Methods:We present three cases of disseminated intracavitary leiomyomatosis. Preoperative imaging studies for these patients showed multiple small fibroids, however the diagnosis was not confirmed until the uterus was surgically evaluated.Results:Case 1: A 31 year old female presented with abnormal uterine bleeding and primary infertility. Preoperative imaging showed multiple submucosal fibroids. This patient had a hysteroscopic myomectomy two years prior. She was taken for a laparotomy/myomectomy and intraoperatively the fibroids were found to be subendothelial; nearly 40 fibroids were resected. Case 2: A 37 year old female presented with primary infertility. This patient had a previous hysteroscopic myomectomy. Imaging studies reported multiple submucosal and intramural fibroids. Intraoperatively the entire endometrial cavity was lined with 2cm subendothelial fibroids; over 30 fibroids were removed. Case 3: A 37 year old female presented with abnormal uterine bleeding. The bleeding was not well managed with medical therapy. Intraoperatively she was found to have multiple 1cm subendothelial fibroids. She was managed with Lupron and multiple hysteroscopic procedures for resection for these fibroids.Conclusion:Intracavitary subendothelial leiomyomas have not been widely described in the literature. The diagnosis can be challenging as imaging modalities are unable to distinguish subendothelial from submucosal leiomyomas. These patients also had hysteroscopic procedures prior to development of intracavitary leiomyomatosis. In our cases, the diagnosis was made intraoperatively and resulted in the removal of a large number of leiomyomas.
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