Large uterine leiomyoma: a literature review and a clinical case report of a 16-year-old girl

Lisitsyna O.I., Khashchenko E.P., Kyurdzidi S.O., Uvarova E.V., Asaturova A.V., Zurabiani Z.R., Chuprynin V.D.

1) Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia; 2) I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia

Background: Uterine leiomyoma is extremely rare in adolescence (less than 1%). The reason for seeking health care in these patients is complaints of copious and painful menstruation, tensive pains in the lower abdomen, and abdominal enlargement. However, given that uterine fibroids are asymptomatic and the mass often reaches large sizes by the time of diagnosis in most cases. In the above situations, the possibility of performing organ-sparing treatment is of particular importance.
Case report: The paper reviews the data available in the literature and describes a rare clinical case of large uterine fibroids in a 16-year-old girl. The patient and her parents visited a physician for complaints of copious painful menstruation and an abdominal enlargement. Pelvic magnetic resonance imaging revealed an intramural uterine fibroid measuring 123×74×121 mm (the uterus measuring 148×107×128 mm) originating from the left rib at the level of the corpus uteri. The mass substantially distorted the uterine cavity. The patient was referred to the Center for hospitalization. She received surgical treatment: laparoscopy with transition to transverse suprapubic laparotomy; myomectomy without uterotomy; and autoerythrocyte reinfusion. Morphological examination diagnosed uterine leiomyoma with edema and hyalinosis. Immunohistochemical examination of the expression of H-caldesmon confirms the smooth muscle nature of the tumor and analysis of the expression of PHH3, Ki-67, p53, and p16 indicates its low mitotic activity. The postoperative period was uncomplicated. The patient was discharged home in a satisfactory condition to be followed up by an obstetrician/gynecologist at her residence. At 2 months after surgery, control pelvic ultrasound examination showed no abnormalities.
Conclusion: Despite the rare frequency of uterine fibroids in childhood, these clinical cases are encountered in the practice of an obstetrician/gynecologist. In order to early diagnose pelvic organ diseases and to perform timely organ-sparing treatment, all teenage girls are indicated to undergo routine preventive examinations, including ultrasound study.

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About the Authors

Olga I. Lisitsyna, Resident, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, o_yazykova@inbox.ru, https://orcid.org/0000-0002-7775-3508, 4, Oparina str., Moscow, 117997, Russia.
Elena P. Khashchenko, PhD, Researcher of Gynecology of children and adolescents Department, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, khashchenko_elena@mail.ru, https://orcid.org/0000-0002-3195-307X. 4, Oparina str., Moscow, 117997, Russia.
Stanislav O. Kyurdzidi, postgraduate student, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation,
dr.kyurdzidis@gmail.com, https://orcid.org/0000-0002-6316-1325, 8-2, Trubetskaya str., Moscow, 119991, Russia.
Elena V. Uvarova, Dr. Med. Sci., Professor, Corresponding Members of the RAS, Head of 2nd Gynecological (child and adolescent) Department, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, elena-uvarova@yandex.ru,
https://orcid.org/0000-0002-3105-5640, 4, Oparina str., Moscow, 117997, Russia.
Zaira R. Zurabiani, PhD, obstetrician-gynecologist of Gynecologic Department, Academician V.I. Kulakov National Medical Research Center of Obstetrics,
Gynecology and Perinatology, Ministry of Health of the Russian Federation, z_zurabiani@oparina4.ru, 4, Oparina str., Moscow, 117997, Russia.
Aleksandra V. Asaturova, PhD, Head of 1st Pathology Department, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, a_asaturova@oparina4.ru, https://orcid.org/0000-0001-8739-5209, 4, Oparina str., Moscow, 117997, Russia.
Vladimir D. Chuprynin, PhD, Head of General Surgery department, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation, v_chuprynin@oparina4.ru, 4, Oparina str., Moscow, 117997, Russia.

Authors' contributions: Khashchenko E.P., Uvarova E.V. – concept and design of the investigation; Lisitsyna O.I., Khashchenko E.P., Kyurdzidi S.O., Uvarova E.V. – writing and editing the text; Khashchenko E.P., Zurabiani Z.R., Kyurdzidi S.O., Uvarova E.V., Lisitsyna O.I. – patient management and treatment; Asaturova A.V. – conducting and analyzing a morphopathological study.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
Patient Consent for Publication: The patient's mother provided informed consent for the publication of data and associated images.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.

For citation: Lisitsyna O.I., Khashchenko E.P., Kyurdzidi S.O., Uvarova E.V., Asaturova A.V., Zurabiani Z.R., Chuprynin V.D. Large uterine leiomyoma: a literature review and a clinical case report of a 16-year-old girl.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 9: 180-188 (in Russian)
https://dx.doi.org/10.18565/aig.2021.9.180-188

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