Giant uterine leiomyomas (>10 cm) are uncommon in the modern imaging era and may mimic ovarian malignancy due to their size and heterogeneous appearance, posing a diagnostic and therapeutic challenge. A 34-year-old nulliparous woman presented with progressive abdominal distension and pelvic pressure. Imaging revealed a 19 × 14 cm multinodular uterine mass with heterogeneous features and preserved surrounding fat planes. Given the patient's strong desire for uterine preservation, an open abdominal myomectomy was performed. A highly vascular, multicompartmental leiomyoma arising from the uterine body was successfully enucleated with vasopressin-assisted hemostasis and meticulous multilayer myometrial reconstruction. Estimated blood loss was 1000 ml without transfusion. Histopathology confirmed a benign leiomyoma. The postoperative course was uneventful. This case highlights that, despite their size and complexity, giant multicompartmental leiomyomas can be safely managed with uterine-preserving myomectomy in carefully selected patients. Adequate preoperative assessment, intraoperative vascular control, and advanced reconstructive techniques are critical to guide surgical decision-making and optimize outcomes.
Freire et al. (Wed,) studied this question.
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