A 41-year-old woman (G3P2L2Ab1) was referred to gynecology clinic with chief complaints of abdominal distension and localized abdominal wall pruritus for three months. She was misdiagnosed with gastrointestinal disorder and ultimately had undergone imaging. Ultrasonography and computed tomography (CT) scan disclosed a huge solid-cystic mass originating from the ovary. On clinical examination the patient had no pain or tenderness and no gynecologic complaints. Laboratory tests showed normal tumor markers and hemoglobin at 8 g/dl. Laparotomy was carried out as diagnosis of ovarian serous cyst adenoma, but a huge tumor with attachment to uterus and ovaries and extension to pelvic floor, peripheral tissues of ureter, and upper abdomen was found. Hysterectomy with bilateral salpingooophorectomy was done. Pathology report demonstrated uterine leiomyosarcoma measuring 40 centimeters and weighing 10 kilograms. In conclusion, as pelvic masses even in a large size may present unspecific symptoms misdiagnosis may occur which lead to overgrowth, local invasion, or other complications. So, it is rather to suggest ultrasonography in patients with persistent abdominal or pelvic symptoms and if needed, more exact diagnostic modalities like magnetic resonance imaging (MRI) could be offered to avoid misdiagnosis and mismanagement.
Pelvic masses are common findings in general gynecology [
A 41-year-old woman (G3P2L2Ab1) was referred to gynecology clinic with chief complaints of abdominal distension and localized abdominal pruritus for three months. To rule out gastrointestinal disorders, she had visited a general physician given her symptoms. But she found no response to the drugs in spite of a long-term usage and was referred to our clinic after taking ultrasonography. Her past history showed menorrhagia but not menstrual irregularity and dysmenorrhea for several months. Laboratory tests including hemoglobin at 8 g/dl, hematocrit at 28,7%, ferritin at 6 ng/ml, and iron at 29 mcg/dl approved this claim but the patient had not expressed it initially as a complaint. Vital signs were in normal limits. In general appearance, the patient was not cachectic with full activity without vertigo, impairing appetite, constipation, nausea, vomiting, and urinary symptoms, but a distended abdomen that lacks rebound and tenderness. The origin of the mass was not detectable by vaginal examination. Ultrasonography had revealed a huge multicystic septated mass, 40 cm in diameter in abdominal cavity, probably a serous cystadenoma originating from ovary that was extended to epigastric area. Uterine and bladder were reported normal; however, these were impressed by extrinsic pressure of the mass. Uterine observation was not possible with vaginal sonography due to huge ovarian tumor. Tumor markers including cancer antigen-125, carcinoembryonic antigen,
Intravenous contrast CT scan showing a large septated solid-cystic mass with report of serous cyst adenoma.
Gross appearance of tumor.
Microscopic appearance of tumor cells.
Leiomyosarcomas (LMS) are the most common sarcomatous malignancies of uterus that represent 1-2% of all uterine malignancies [
The absolute diagnosis of uterine leiomyosarcoma is made by histologic confirmation. In most cases, the diagnosis of these tumors is made by specimen examination in hysterectomized patients who was managed as leiomyoma [
The main treatment of LMS is surgical excision which consists of total abdominal hysterectomy and debulking of any tumor invading outside the uterus. It is considered appropriate to preserve ovaries in young women and routine dissection of pelvic and para-aortic lymph nodes, since lymph node involvement is seen in less than 3% of patients [
In conclusion, pelvic masses even in a large size may be without any specific symptoms. Delay in diagnosis may lead to overgrowth, torsion, or hemorrhagic tear of tumors and invasion to surrounding visceral organs. So, it is considered more appropriate to suggest ultrasonography in patients with persistent abdominal pain or distension who do not respond to recommended drugs and in case of presence of a mass, MRI as a preferable imaging could be offered to avoid misdiagnosis.
The authors declare that they have no conflicts of interest.
The authors would like to thank the authorities and the staff of Mobini Hospital for their contribution and cooperation in performing the patient follow-up.