Asian Journal of Case Reports in Surgery

Background: Giant subserosal uterine leiomyomas are uncommon and may present as large abdominal masses with relatively few symptoms. This report describes the diagnosis and fertility-preserving surgical management of a giant subserosal leiomyoma in an infertile woman.

Case Presentation: A 37-year-old nulliparous woman presented with abdominal fullness for one and a half years. She had been married for 12 years and had previously received treatment for infertility without benefit. Physical examination revealed a large, smooth, non-tender abdominopelvic mass extending to the epigastrium. Routine laboratory investigations were within normal limits. Computed tomography demonstrated a poorly enhancing mass arising from the uterine fundus, measuring 25 × 23 × 13.5 cm, displacing the bowel loops laterally and requiring exclusion of malignancy.

Intervention: Open laparotomy and myomectomy were performed. The giant subserosal mass was enucleated, while the uterus and adnexa were preserved. The excised specimen weighed 4.5 kg. Histopathological examination showed a hypercellular spindle-cell lesion arranged in intersecting fascicles and whorls within a myxoid matrix, without cytological atypia, confirming myxoid leiomyoma.

Outcome: The postoperative course was uneventful, and examination and investigations at one-year follow-up were normal.

Conclusion: Giant subserosal leiomyoma should be considered in women of reproductive age presenting with marked abdominal distension. Careful imaging, operative planning, and uterus-preserving excision may provide effective management when future fertility is desired.