Enlarged uterine fibroid forming uterine diverticulum during
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A 25-year-old nulligravida woman had an abnormal uterine cavity surrounded by myomatous mass. After natural conception, the mass and pouch had enlarged during pregnancy. Six months after elective cesarean delivery, she underwent laparotomy because of abdominal pain caused by the myomatous mass and the fluid inside. The tumor was connected to the midline of the posterior wall of the normal uterus. The resected tumor was pathologically diagnosed as leiomyoma and diverticulum. Pregnancy can stimulate uterine fibroids to form uterine diverticula. Resection of the diverticulum and fibroid is a useful option for symptomatic patients with desired future fertility.

She had no history of gynecological diseases, procedures, or uterine trauma. Her menstrual cycle was regular without any symptoms. MRI revealed a myomatous mass with homogenous intensity present on the posterior uterine wall close to the internal ostium of the uterus, which shaped the inner pouch structure that was filled with a small amount of fluid (Fig. 1a). Upon initial examination, it appeared to be a rudimentary uterine horn; however, hysterosalpingography showed the patency of bilateral fallopian tubes connected with the fundus of the anterior uterus.

Although the pregnancy was uneventful after natural conception, the myomatous mass and the pouch had become enlarged (Fig. 1b). At 38?+?4 gestational weeks, the patient underwent an elective cesarean delivery because the enlarged mass interfered with a vaginal delivery. Although involution of the uterus was uneventful and her menstruation did not occur during the four months after delivery, she presented at our department again with lower abdominal pain. The normal uterus was empty and about 7 cm in size. MRI showed that the myomatous mass was just as large as it was during pregnancy, and the fluid inside the myomatous mass had increased (Fig. 1c).

To improve her abdominal symptoms, she underwent laparotomy six months after delivery. During laparotomy, the uterus was completely normal with normal fallopian tubes and ovaries. A hard mass was found behind the uterus covered by thin serosa (Fig. 2a) and connected to the posterior uterine wall in the mid-line (Fig. 2b). The root of the tumor was about 3 cm in diameter. The tumor was taken out after incision of the root. The resected mass was about 18 cm in diameter and weighed approximately 1100 g. Macroscopically, the mass was a homogenous white pink hard tumor. The microscopic histological diagnosis was leiomyoma. The inner pouch space was covered with inner cervical mucosa, with inner cervical glands filled with a brownish mucosal fluid (Fig. 3). The final diagnosis was uterine fibroid and diverticulum. After surgery, her abdominal symptoms resolved, and her regular menstruation resumed for six months.