A RARE CASE OF SUBSEROSAL LEIOMYOMA WITH CYSTIC DEGENERATION MIMICKING AN OVARIAN NEOPLASM-CASE REPORT

Introduction: Leiomyoma of the uterus is the most common tumor arising from uterine smooth muscle. The size varies from microscopic to giant. We report an unusual case of a large leimyoma with cystic degeneration mimicking an ovarian neoplasm. Presentation of case: A 39-year-old Multiparous woman pre­sented with a history of dull aching lower abdominal pain for a period of 1 months. She had no history of serious illness or surgical proce­dures­ and no family history of genitalmalignancy.She is known case of hypothyroidism and oneltroxin 100 mcgper day since 1 year treatment.On Clinical PV examination­revealed uterus around 24 weeks size with the restricted mobility .Mass felt was of a variable consistency. Sono­graphy examination showed Uterus normal .right adnexal mass 125x89x106m withlow resistance vascularity. MRI Pelvis report showed Large well defined encapsulated T2 hyperintenselesion withintralesional enhancing frond like soft tissue component and septa along the inferior aspect of lesion arising from the right adnexa and extending into the lower abdomen, abutting the both ovaries posterolaterally and relation with the adjacent structure as described above- likely represent right adnexal cystic neoplasm. However, the possibility of exophytic ovarian neoplasm cannot be be completely excluded. Blood Investigation shows Alpha feto protein-2.7ng/ml,CA-125-13.60u/ml,CEA-0.8ng/ml,B-HCG-<1.2mIU/ml. With clinical examination and sonography and MRI diagnosis of ovarian cancer was made and patient kept for staging laprotomy for ovarian cancer. The patient underwent laparotomy, After opening the abdomen there was mass of about 24 weeks size pregnancy. Seems to be related to bladder. So, cystoscopy was performed by urologist.findings on cystoscopy shows normal urethral opening,normal ureteral openinig. Bladder was normal. Once we we excluded any lesionin the bladder.Cyst was enucleated from the anterior wall of the uterus while during dissection cleavage was found with minimal bleeding,followed by abdominal hysterectomy and removal of both sides of fallopian tubes..The histology revealed a subserosalleiomyoma with cystic degeneration. Discussion: Cystic degeneration of subserosal fibroid of uterus mimicsovarian tumor both clinically and ultrasonographically and MRI also. Conclusion: cystic degeneration of subserosalleiomyomas should be consideredin the differential diagnosis of a multilocular and predominantly cystic adnexal mass.