A 46-year-old perimenopausal woman, with a history of previous three caesarean sections, presented with progressive abdominal distension, heavy and prolonged menstrual bleeding, and fatigue over several months, accompanied by poor appetite and lower abdominal discomfort. She experienced two episodes of severe vaginal bleeding with syncope, resulting in very severe anaemia and thrombocytopenia, necessitating multiple transfusions of packed red blood cells (PRBCs) and fresh frozen plasma (FFP). Clinical examination revealed pallor, tachycardia, and a massive firm, irregular abdominopelvic mass with hepatosplenomegaly. Laboratory investigations confirmed anaemia, thrombocytopenia, and hyperbilirubinemia. Imaging identified a massive uterine fibroid (measuring up to 32.2 × 28.4 cm) with degenerative changes and heterogenous fluorodeoxyglucose (FDG) uptake, associated with ureteric compression, hepatosplenomegaly, and mild ascites. Multidisciplinary evaluation, including bone marrow biopsy excluded marrow suppression. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) and liver biopsy. Intraoperatively, a large, lobulated uterine mass with multiple fibroids and myxoid degeneration was confirmed, weighing 8.3 kg; intraoperative frozen section and final histopathology confirmed benign leiomyomas. Liver biopsy and ascitic fluid cytology were negative for malignancy. The postoperative course was uneventful, with close monitoring and supportive transfusions. This case highlights a rare presentation of giant uterine leiomyomas causing life-threatening anaemia and coagulopathy, mimicking malignancy and necessitating a multidisciplinary approach with definitive surgical management
Vijay Kumar Ujjwala (Sun,) studied this question.