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case_images: a, b- Clinical photographs showing abdominal distension, (a)- right lateral view in addition showed a post appendectomy scar on the right lower abdomen. (b), from the foot of the bed showing asymmetrical distension, more on the right side.
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case_images: The abdomen was asymmetrically distended with a swelling that was estimated to have a fundal height of 32 weeks in the right half of the abdomen and extended across the midline, Figure 1(a) and (b). There was an oblique scar in the right iliac fossa from appendectomy Figure 1(a).
case_images: a, b- CT- Axial section showing intraabdominal mass with degenerative changes (red arrow), (b)-CT- Sagittal section showing abdominopelvic mass with "ultrashort pedicle sign" (blue arrows), dystrophic calcification of cervical myoma (brown arrow) and cystic degenerative changes (red arrow).
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case_images: Abdominopelvic CT scan presented in the clinic showed a huge loculated cystic hypodense intrabdominal mass with thick enhancing wall occupying predominantly the right flank and measured 18.4 cm, Figure 2(a). Uterus was reported as bulky with AP dimension of 8 cm showing a calcified myoma (5.0 x 5.5 cm) in its myometrium that compressed the adjacent bladder, Figure 2(b).
case_images: (a)- Large subserous uterine leiomyoma insitu, (b)- Intraoperative, demonstrating the ultra-short pedicle.
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case_images: Large subserosal pedunculated spherical uterine mass, FIGO type 7 that measured about 25 cm in the widest dimention that arose from the right side of the fundus of the uterus, Figure 3(a) and (b). A huge mass was delivered that revealed a large subserous uterine mass with an ultra-short peduncle attached to the right side of the uterine fundus, FIGO 7, Figure 3(a) and (b).
case_images: (a)- Multiple subserous leiomyomas (blue arrows), right ovary (yellow arrow), (b)- cervical leiomyoma (blue arrow) and adenomyosis (green arrow).
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case_images: Spherical subserosal uterine mass (that measured 3.5 cm in the widest dimention) attached to the supero-anterior aspect of the uterus, Figure 4(a). Intra-uterine mass located at the anterior part of the fundus, Figure 4(b). Another relatively smaller subserous masses was also noted, Figure 4(a). The Gynecologist who was invited discovered and removed another uterine mass located at the cervix, Figure 4(b), alongside another subserous mass, 4a. There was associated focal adenomyosis in the left fundal area also excised, (Figure 4(b)-part held between the thumb and fingers).
case_images: (a)- Gross picture of subserous uterine leiomyoma- site the attachment of the pedicle (green arrow). (b)- Gross picture of subserous uterine leiomyoma (red arrow), Leiomyoma of the uterine cervix (blue arrow).
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case_images: Skin was apposed with polyamide 2/0 interrupted vertical mattress sutures and the harvested specimens sent for histology, Figure 5(a) and (b).
case_images: Cut surface of intraabdominal subserous uterine leiomyoma, showing multiple cystic spaces, largest 10.5 cm in the widest dimension and the smallest 0.5 cm.
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case_images: Cut surface of the largest mass (subserous uterine mass) showed multiple cystic spaces, the largest measured 10.5 cm and smallest 0.5 cm across the widest dimensions, Figure 6.
case_images: a, b- Uterine leiomyoma. (a)- Histology of intraabdominal subserous uterine leiomyoma showed bundles of smooth muscle fibers that were haphazardly arranged, individual muscle fibers were spindle shaped with bipolar eosinophilic cytoplasm with cigar shaped nuclei. (b)- showed hyaline degeneration. There was no atypia, (c)- Uterine adenomyosis, blue arrow-endometrial glands, red arrow-endometrial stroma, yellow arrow-myometrium.
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case_images: Furthermore, this uterine leiomyoma showed degenerative changes (hyaline and cystic), Figure 7(a) and (b). The individual muscle fibers were spindle shaped with bipolar eosinophilic cytoplasm with cigar shaped nuclei-uterine adenomyosis, Figure 7(c).