Gynecology World Conference 2026

Abstract

Giant pedunculated subserosal leiomyomas are uncommon and may closely mimic ovarian neoplasms when cystic degeneration produces a complex adnexal-type appearance. We report a 43-year-old multiparous woman with an 18-year history of progressive abdominal heaviness and intermittent pain, worsening menorrhagia with dysmenorrhoea over 3 years, urinary frequency, and stress incontinence. Clinical examination revealed a firm abdominopelvic mass corresponding to a 30-week gravid uterus. Haemoglobin was 10.1 g/dL and CA-125 was 9.37 U/mL.

Ultrasonography demonstrated an enlarged fibroid uterus and a large multiloculated cystic lesion extending into the upper abdomen, raising suspicion of ovarian neoplasm. MRI established uterine origin by showing two giant well-circumscribed masses attached to the uterus by broad stalks with tortuous bridging vessels and small cystic foci, favouring pedunculated subserosal leiomyomas with degeneration. Because a small indeterminate right adnexal lesion persisted, FDG PET-CT was used selectively and showed no FDG-avid nodal or distant disease, lowering concern for disseminated malignancy without excluding sarcoma.

The patient underwent total abdominal hysterectomy with right salpingo-oophorectomy and left salpingectomy through a midline vertical incision. Histopathology confirmed leiomyoma with cystic degeneration without atypia or malignancy. This case highlights that in giant complex abdominopelvic masses, the key preoperative issue is determination of organ of origin rather than morphology alone. MRI, particularly the bridging vessel sign, is highly valuable in preventing misclassification as ovarian malignancy and avoiding inappropriate oncological staging.