A case of FIBROID!! WHAT'S NEW ???
A 41 yr old lady came with c/o excessive bleeding during cycles since 4 months and pain abdomen since 2 months. On examination, a 18x12x12 cms size mass is palpable per abdomen, corresponding to a 20 wks pregnant uterine size, in hypogastrium and left iliac fossa and lumbar region upto umbilicus, and on right side upto right iliac fossa and on bimanual vaginal examination same mass palpable except in right fornix which is firm in consistency and cervix is moving with the movement of mass per abdomen.
Uterus well defined, abdomino-pelvic soft tissue attenuating mass lesion measuring 18 x 10.4 x 12cms and 8.5 x 8.4 x 10.1cms seen arising from left adnexa.
-Uterine vessels are seen between uterus and the mass lesion.
-Mass is seen – displacing uterus anteriorly and superiorly and displacing bilateral ureters laterally causing mild compression leading to bilateral hydronephrosis.
-Lower end of largest lesion is seen extending into vagina, however exact delineation of lesion in vagina couldn’t be made out.
-Ovaries: not made out.
-Mildly enlarged para-aortic lymphnodes noted.
Uterine artery doppler:
-Increased diastolic flow noted in the left uterine artery.
-Normal flow velocities noted in right uterine artery.
@What could be site of origin of this fibroid ???
-How do you think the case can be managed ?? *Do you think any precautionary measures to be taken to avoid injury to the ureters ??
Post operative histopathological features:
-Cervix: chronic non specific cervicitis
-Endometrium: Disordered proliferative phase
-Myometrium: Multiple leiomyomata
-Oneside ovary: Follicular cyst and corpus hemorrhagicum and paratubal cyst
-Otherside ovary: corpus albicantis
-Right tube: hydrosalpinx
-Left tube: NAD