Fertility-Sparing Approach in a Teenager with Uterine Tumor Diagnosed as a Sarcoma on Imaging

Berveiller, Paul; Mir, Olivier; Menu, Y.; Jamali, Maryam; Carbonne, Bruno

doi:10.1159/000264681

Cited by 6 publications

(8 citation statements)

References 10 publications

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“…[1][2][3][4] Their occurrence in the adolescent population (under the age of 20 years) is infrequent and relatively few cases have been documented in the literature. [5][6][7][8][9][10][11][12] The aetiology of leiomyomas in adolescents and adults is generally unknown, but leiomyomas are known to grow in response to both oestrogen and progesterone stimulation, and their prevalence increases throughout the reproductive years and is markedly reduced after menopause. [5][6][7][8] Higher concentrations of oestrogen and progesterone receptors, as well as aromatase, have been observed in fibroids compared to normal myometrial tissue.…”

Section: Discussionmentioning

confidence: 99%

Uterine leiomyoma in a 19-year-old girl: Case report and literature review

2016

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A previously healthy 19-year old female presented to the gynaecological clinic with gradual abdominal distension for six months, associated with progressive abdominal discomfort. There was no history of nausea, vomiting, weight loss, or anorexia. She reported no changes in bowel habits and denied genitourinary symptomatology. Menarche occurred at 14 years of age, and her menstrual periods had always been regular. She denied recent sexual activity and was not currently taking oral contraceptives. The remainder of the patient's history, including a focused family history, was non-contributory. Physical examination revealed the presence of a somewhat firm, irregular, nontender, and mobile mass arising from the pelvis, corresponding in size to a pregnant uterus of 24 weeks' gestation. Laboratory analysis showed a blood haemoglobin concentration of 12.6 g/dL. The remainder of her laboratory results were within physiological parameters, and pregnancy was excluded. Transabdominal ultrasonography revealed globular uterine enlargement and a hypoechoic mass measuring 18 cm × 14 cm. The ovaries and adnexa were not visualized because they were obscured by the enlarged, bulky uterus. Neither ascites nor hydronephrosis was noted. The patient was counselled about the diagnosis of uterine fibroid and underwent exploratory laparotomy after proper counselling and written informed consent. Intraoperatively, the uterus was grossly enlarged by a large fibroid measuring 16 cm x 10 cm ( Figure 1 and Figure 2). Both ovaries and fallopian tubes were normal. The uterus was elevated out of the abdominal cavity and myomectomy of the large tumour was achieved through a fundal incision. The excision site was closed with continuous catgut sutures, and the abdomen was closed in layers. Cut section of the gross specimen revealed whitish nodules with a whorled appearance and fibroelastic consistency suggestive of benign leiomyoma (Figure 3). The specimen was sent for formal histopathology. Results of histopathological examination confirmed the diagnosis of a benign fibroid of the uterus. The patient's postoperative course was uneventful, and she was discharged on postoperative day seven. A six-month follow-up with repeat ultrasonography was arranged. Counselling regarding recurrence and future fertility was offered before discharge. Though our client was an adolescent and denied being sexually active, she was offered family planning counselling and advised not to conceive for at least one year to allow wound healing and full recovery. DiscussionUterine leiomyomas (also called fibroids) are benign growths that represent the most common neoplasms of the uterus, affecting 20% to 30% of women between the ages of 30 and 50 years.1-4 Their occurrence in the adolescent population (under the age of 20 years) is infrequent and relatively few cases have been documented in the literature. 5-12The aetiology of leiomyomas in adolescents and adults is generally unknown, but leiomyomas are known to grow in response to both oestrogen and progesterone stimulati...

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Section: Discussionmentioning

confidence: 99%

Uterine leiomyoma in a 19-year-old girl: Case report and literature review

2016

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“…Uterus leiomyomas are extremely uncommon in the paediatric and adolescent population [5–11]. Approximately twelve cases of uterine leiomyomas among teenagers, under the age of 18 years have been reported in the English language literature [5–11].…”

Section: Discussionmentioning

confidence: 99%

“…As to our knowledge, this is the first report of a uterus with multiple fibroids in an adolescent girl in the English literature, although there are few reports of solitary uterus leiomyomas in this age population [5–11]. The value of preoperative imaging evaluation in these patients is discussed.…”

Section: Introductionmentioning

confidence: 87%

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Fibromatous Uterus in a 16-Year-Old Girl: A Case Report

Tsili

Lentoudi

Argyropoulou

et al. 2010

Case Reports in Medicine

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Although uterine leiomyomas are the most common neoplasms of the female genital tract, this is not the case when referring to women under the age of 20. Only a few cases of uterus leiomyomas have been reported in this age. Preoperative imaging evaluation is mandatory in adolescent women for the accurate detection, localization, and characterization of uterus leiomyomas. We report a case of a 16-year-old girl admitted to our hospital for pain and abdominal distention. The patient underwent multidetector CT examination of the abdomen and MR examination of the pelvis. Both imaging modalities revealed uterine enlargement and the presence of innumerable variably sized leiomyomas. Histopathologic examination following exploratory laparotomy confirmed the presence of uterus leiomyomas. The patient underwent laparoscopic myomectomy two years after the first operation, following MR examination of the pelvis.

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“…In the literature, only 14 cases of uterine myomas have been reported in females between 13 and 18 years of age. 2,[4][5][6][7][8][9][10][11][12][13][14][15] In this report, the case of a uterine myoma is described in a 14-year-old girl who presented with lower abdominal and back pain and irregular menses.…”

Section: Introductionmentioning

confidence: 99%

A Case of Large Uterine Myoma in a 14-Year-Old Girl

Maggiore

Ferrero

Bogliolo

et al. 2013

Journal of Gynecologic Surgery

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Uterine myomas are the most common tumors of the female genital tract; they are mesenchymal tumors that arise from smooth-muscle cells and extracellular matrix of the uterus. They are less common in adolescents than in adults, and their clinical presentation is usually represented by abdominal/back pain, menstrual disorders, and vaginal bleeding. Case: The case report is described of a 14-year-old girl who presented to our Institution with the chief complaint of menstrual disorders (menorrhagia), and abdominal and back pain. The abdominal examination revealed a large mass extending 3 cm above the umbilical-transverse line. Abdominal ultrasound and magnetic resonance imaging (MRI) confirmed the presence of a mass that originated from the myometrium of the posterior uterine wall. The patient received an intramuscular injection of leuprolide acetate (3.75 mg, Decapeptyl, Ipsen, Rome, Italy) in order to reduce the volume of the mass before surgery and to decrease the intraoperative blood loss. Twenty-two (22) days after the first injection of leuprolide, the patient was admitted again to our Department because of fever and intense abdominal pain of increasing severity. Microscopic ex- amination, immunohistochemical and the cytological examination of the fluid found in the pouch of Douglas during surgery confirmed the benign nature of the uterine mass, hypothesized through clinical and imaging examinations. Results: At 2-year follow-up, no recurrence of myoma was observed. Conclusions: Large uterine myomas may be diagnosed in adolescents. Before surgery, combining ultrasonography with MRI permits precise information to be obtained on the nature of the mass. Fertility sparing and low surgical injury are mandatory in this population

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Fertility-Sparing Approach in a Teenager with Uterine Tumor Diagnosed as a Sarcoma on Imaging

Cited by 6 publications

References 10 publications

Uterine leiomyoma in a 19-year-old girl: Case report and literature review

Uterine leiomyoma in a 19-year-old girl: Case report and literature review

Fibromatous Uterus in a 16-Year-Old Girl: A Case Report

A Case of Large Uterine Myoma in a 14-Year-Old Girl

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