Giant Leiomyoma of the Retzius Space: A Case Report

Abstract

Extrauterine leiomyoma is a very rare clinical condition; we report a case of leiomyoma of the Retzius space in a 49-year-old women who suffered for two years from bladder voiding symptoms characterized by dysuria, feeling of incomplete emptying, and pelvic pain. Clinical evaluation and abdominal and transvaginal ultrasound suggested the presence of a voluminous (about 10 cm in diameter) fibromyoma of the anterior uterus surface. The urodynamic evaluation demonstrated the presence of bladder outlet obstruction (voiding pressure greater than 20 cm H2O and maximum flow rate less than 12 mL/s) with a postvoiding urine residual equal to 80 mL; moreover, the presence of cystocele and urethral stricture was ruled out performing clinical evaluation, cystography, and cystourethroscopy. The patient underwent laparotomy to remove the uterine fibromyoma. Intraoperatively, a voluminous soft mass arising from the Retzius space was found; it was firmly adhered to the uterus with obliteration of vesicouterine pouch owing to severe adhesion to the anterior surface of uterus. The tumour was isolated, enucleated from the prevesical space, and removed; moreover, the patient became asymptomatic after surgery. In conclusion, leiomyoma of the Retzius space is a very rare benign tumour that should be considered in the presence of severe bladder voiding symptoms.

Leiomyoma of the Retzius space in a male patient: A case report and a diagnostic approach to Retzius space diseases

“…For this reason, a biopsy may be considered although no case of leiomyosarcoma in this space has been reported. Leiomyomas in Retzius space can be clinically silent and may be discovered incidentally, like in our case, however, when they grow in size, they can cause symptoms such as voiding difficulties …”

“…However, there is paucity of reports in the literature about diseases developing in the Retzius space. The majority of cases reported are leiomyomas and so far, there have been only 7 cases, all of them in female patients . The rest of the cases involving tumors include a cystic lymphangioma, an angiomyxoma and a spindle cell lipoma .…”

“…Leiomyomas in Retzius space can be clinically silent and may be discovered incidentally, like in our case, however, when they grow in size, they can cause symptoms such as voiding difficulties. 6 In summary, the diagnostic approach to Retzius space's diseases should be based on the assessment of the lesion's origin, its cystic versus solid nature and the patient's clinical history. Transrectal ultrasound is the first-line modality for imaging this anatomical region with MRI being used to further characterize solid masses.…”

“…Leiomyomas are the most common tumors found in this location, yet only 7 cases have been reported in the literature so far, all of them described in female patients. [1][2][3][4][5][6] We report a unique case of a leiomyoma of the Retzius space in a male patient and discuss an imaging-based diagnostic approach to diseases affecting the space of Retzius. angiomyxoma and a spindle cell lipoma.…”

Uterine Reconstruction Due to a Giant Myoma. A Case Report and Literature Review

“…However, an exact prevalence is difficult to determine. The symptoms include a wide range of possibilities such as [8]: menometrorrhagia, pelvic pressure, urinary symptoms due to compression of urethra with hydro-nephrosis [9] or bladder compression with symptoms of urgency and urge incontinence [10], edema, or pelvic varices MMII, thrombosis or compression symptoms sacral plexus. Other symptoms described included unusual pulmonary hypertension, respiratory failure [11], pseudo-Meigs syndrome [12], difficulty to walk, tiredness [13] and arthrogryposis in pregnancy [14].…”