Leiomyoma in the Douglas' pouch
Abstract
Leiomyomas (myoma, fibromyoma or fibroid) are benign tumors of smooth muscle cells. They are predominantly localized in the body of the uterus, but they can also develop in the broad ligament, ovaries, cervix, Douglas space and round ligament. Their frequency ranges from 5.4 to 77%, depending on the population examined or the applied diagnostic technique. Most leiomyomas are asymptomatic, but can present with a wide range of symptoms. Treatment includes pharmacological treatment and surgical treatment.
A patient with a leiomyoma of the Douglas space coexisted with leiomyomas of the uterine body. Apart from intense pain in the lower part of the stomach, she had no other symptoms. Abdominal ultrasound examination, transvaginal ultrasound examination and computer tomography revealed an enlarged, myomatous uterus and a tumoral change on the right ovary. In an extensive operation, the uterus and both fallopian tubes were removed. The final diagnosis of a tumor changes in Douglas' space, which was initially considered a potentially malignant tumor of the right ovary, was established by a pathohistological examination after the operation.
Leiomyomas are relatively common benign tumors of the uterine body. Their early diagnosis during a gynecological examination enables timely treatment that avoids hysterectomy and maintains fertility. Leiomyomas of atypical localization have a low incidence and an unclear clinical picture, and their final diagnosis is predominantly made after surgery.
References
2. Sparic R, Mirkovic L, Malvasi A, Tinelli A. Epidemiology of Uterine Myomas: A Review. Int J Fertil Steril. 2016 Jan-Mar;9(4):424-35. Dostupno na: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4793163/
3. Arno E. Commandeur, Aaron K. Styer, Jose M. Teixeira, Epidemiological and genetic clues for molecular mechanisms involved in uterine leiomyoma development and growth, Human Reproduction Update, Volume 21, Issue 5, September/October 2015, Pages 593–615, https://academic.oup.com/humupd/article/21/5/593/566681
4. Sefah N, Ndebele S, Prince L, Korasare E, Agbleke M, Nkansah A, Thompson H, Al-Hendy A and Agbleke AA. Uterine fibroids — Causes, impact, treatment, and lens to the African perspective. Front.Pharmacol. 2023;13:1045783. . https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.1045783/full 5. Williams ARW. Uterine fibroids - what's new? F1000Res. 2017 Dec 7;6:2109. Dostupno na: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721931/ 6. Noutakdie Tochie J, Therese Badjang G, Ayissi G, Sama Dohbit J. Physiopathology and Management of Uterine Fibroids [Internet]. Fibroids. IntechOpen; 2021. Dostupno na: https://www.intechopen.com/chapters/73825
7. Nowak M, Bartosik W, Witana W, Nowak K, Wilkusz J. Rapidly growing uterine myoma – should we be afraid of it? Menopause Review/Przegląd Menopauzalny. 2023;22(3):161-164. Dostupno na: https://www.termedia.pl/Rapidly-growing-uterine-myoma-should-we-be-afraid-of-it-,4,51494,1,1.html 8. Florence AM, Fatehi M. Leiomyoma. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Dostupno na: https://www.ncbi.nlm.nih.gov/books/NBK538273/
9. Wilde S, Scott-Barrett S. Radiological appearances of uterine fibroids. Indian J Radiol Imaging. 2009 Jul-Sep;19(3):222-31. Dostupno na: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766886/
10. Biscotti CV, Falcone T. Histopathology of uterine leiomyomas. In: Tulandi T, editor. Uterine Fibroids: Embolization and other Treatments. Cambridge: Cambridge University Press; 2003.11–5. Dostupno na: https://www.cambridge.org/core/books/abs/uterine-fibroids/histopathology-of-uterine-leiomyomas/B19AB75FF866F47649AC8C7FB7570896
11. Palheta MS, Medeiros FDC, Severiano ARG. Reporting of uterine fibroids on ultrasound examinations: an illustrated report template focused on surgical planning. Radiol Bras. 2023 Mar-Apr;56(2):86-94. Dostupno na: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10165971/
12. Taskin MI, Ozturk E, Yildirim F, Ozdemir N, Inceboz U. Primary ovarian leiomyoma: A case report. Int J Surg Case Rep. 2014;5(10):665-8. Dostupno na: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189054/
13. Gunasekaran I, Phansalkar M, Palo LB, Varghese RG. Ovarian Leiomyoma Along with Uterine Leiomyomata: A Common Tumour at an Uncommon Site. J Clin Diagn Res. 2015 Nov;9(11):ED01-2. Dostupno na: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668420/
14. Lodhia J, Gaffur R, Sadiq A, Amsi P, Tsandiraki J, Maro E. Unusual case of broad ligament leiomyoma: A diagnostic and surgical challenge. Clin Case Rep. 2022 Sep 14;10(9):e6350. Dostupno na: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9474899/
15. Thanasa E, Thanasa A, Kamaretsos E, Paraoulakis I, Ziogas A, Kontogeorgis Get al. Large Cervical Leiomyoma of the Uterus: A Rare Cause of Chronic Pelvic Pain Associated with Obstructive Uropathy and Renal Dysfunction: A Case Report. Cureus. 2023 Jan 5;15(1):e33387. Dostupno na: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9898999/
16. Gupta M, Singh P. A Case Series of Fibroids with Atypical Clinical Presentation: A Diagnostic Dilemma. Journal of South Asian Federation of Obstetrics and Gynecology.2020;13(3). Dostupno na: https://www.jsafog.com/abstractArticleContentBrowse/JSAFOG/21665/JPJ/fullText
17.Christodoulou IM, Angelopoulos A, Siaperas P, Ioannidis A, Tellos A, Velimezis G et al. Leiomyoma of the Round Ligament of the Uterus Mimicking Inguinal Hernia. Case Reports in Surgery. 2018:6702494. Dostupno na: https://doi.org/10.1155/2018/6702494
18. Tympa A, Grigoriadis C, Terzakis E, Goudeli C, Melemeni A. Leiomyoma of the uterine round ligament: A case report. Experimental and Therapeutic Medicine. 2021: 1285. Dostupno na: https://www.spandidos-publications.com/10.3892/etm.2021.10720
19. Alshwairikh K, AlOtaibi W, Alshammari S, Alshammari T, Hakami R, Alswayyed M et al. Cystic Ovarian Leiomyoma in a Patient with Progressive Abdominal Pain. Am J Case Rep. 2021 Jun 30;22:e930299. Dostupno na: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255085/
20. Liang G, Wu Z, Zhu L, Ruan F . Case Report: Primary Ovarian Leiomyoma: A Clinical Analysis of Case Series and Literature Review. Front. Med. 2022;9:822339. Dostupno na: https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.822339/full