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

Abstract

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...

Anatomical location of uterine fibroids among women attending a tertiary health facility in a southern Nigerian population

“…The slight difference observed is probably because of the differences in age grouping, but this suggests that women in this century are more likely to be involved in building a career. Results in this study does not agree with the case study by Ernest, Nwakalebela and Mpondo [19] that concluded that there is a rise in incidence of uterine fibroids in adolescents, this is because early menarche, exposure to exogenous oestrogen and other factors like obesity usually influence fibroid growth.…”

Fertility sparing treatment in an infertile patient with severe adenomyosis and a uterine fibroid: a case report

“…2023 May;12(5):1510-1512 early menarche, and exposure to exogenous oestrogen are common factors that affect fibroid development . 13 Because the majority of women with myomas are asymptomatic, the incidence of undiagnosed uterine fibroids is high. Women who are symptomatic are more likely to experience pelvic pain, infertility, pregnancy complications, and excessive uterine bleeding, which can lead to anaemia.…”

Uterine fibroids — Causes, impact, treatment, and lens to the African perspective

“…The values found in many countries on the African continent do not match those from the global perspective ( Figure 5 ), particularly those accepted as the prevalence values for Black women. The majority of the studies revealed fibroid occurrences of less than 30% ( Mutai et al, 2015 ; Ernest et al, 2016 ; Bineta et al, 2018 ; Hortence et al, 2021 ; Adawe et al, 2022 ). There may be severe undercoverage, as some of the available studies do not have access to many regions and are usually conducted in one hospital, resulting in a sampling bias.…”