Giant Uterine Leiomyomatosis Mimicking Uterine Sarcoma: A Case Report

Abstract

Introduction: Uterine leiomyomas are the most common benign pelvic neoplasm in women of reproductive age. Although they are generally asymptomatic and small in size, on rare occasions they may reach giant dimensions, representing a diagnostic challenge when their clinical and imaging characteristics mimic malignancy, particularly uterine sarcoma. Case presentation: We present the case of a 39-year-old patient with progressive increase in abdominal circumference over several years. Imaging studies revealed a uterine mass measuring approximately 30 cm with areas suggestive of degeneration and mass effect on adjacent abdominal structures, raising the differential diagnosis between uterine leiomyomatosis and leiomyosarcoma. Due to suspicion of malignancy, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed without intraoperative complications and with an estimated blood loss of 200 mL. Histopathological examination confirmed the presence of conventional and degenerated uterine leiomyomas with dystrophic calcification and hyalinization, without evidence of malignancy. The patient had a favorable postoperative course. Discussion: Giant uterine leiomyomas constitute an uncommon presentation that may mimic malignant neoplasms, making preoperative diagnosis difficult. In these cases, definitive diagnosis depends on histopathological analysis. Conclusion: This case highlights that large tumor size does not necessarily imply malignancy. Timely surgical management and histopathological examination are essential to establish the definitive diagnosis and guide appropriate treatment.