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case_images: Pre- and postoperative pelvic magnetic resonance imaging (MRI) T2-weighted images. (a) Preoperative sagittal view showing diffusely distributed submucosal leiomyomas in the uterine cavity. (b) One-month postoperative sagittal view. (c) One-year postoperative sagittal view. (d) Preoperative coronal view. (e) One-month postoperative coronal view. (f) One-year postoperative coronal view.
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case_images: T2-weighted images, slightly hyperintense on diffusion-weighted imaging (DWI) sequences, with reduced ADC values. The enhanced scan showed uneven, marked enhancement, with patchy weak/non-enhanced areas within some lesions. The uterine cavity was enlarged, showing patchy high and low signals on T2WI, with no clear enhancement on the enhanced scan (Figure 1a,d). A one-month follow-up revealed a good recovery, with a complete blood count showing Hgb 109 g/L and MRI showing no recurrence of uterine fibroids (Figure 1b,e). A one-year postoperative review showed Hgb 116 g/L and MRI revealed no recurrence of uterine fibroids (Figure 1c,f).
case_images: Hysteroscopic examination images. (a) Large submucosal fibroid protruding into the uterine cavity. (b) and (c) Narrowed uterine cavity with widespread fibroids. (d) Smaller submucosal fibroid located at the uterine fundus.
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case_images: For the first time, we used thoracic tissue forceps (model HJH010708, Hangzhou Kangsheng Medical Equipment Co., Ltd., Hangzhou, China) as cold instruments (Figure 2) to excise submucosal uterine fibroids.
case_images: Thoracic tissue forceps. (a) Overall form of the tissue forceps. (b) The head of the forceps is round and blunt to minimize damage to the surrounding tissues, yet the contact surface of the forceps' tip is relatively sharp, enabling effective removal of the tumor while preserving the integrity of the surrounding tissues.
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case_images: Multiple uterine fibroids were observed within the cavity, some with rich surface vasculature, ranging in size from ~ 0.5 to 2-3 cm (Figure 3).
case_images: Placement of the hysteroscopic balloon. (a) Hysteroscopic balloon stent and adhesion barrier placement. (b) Adhesion barrier wrapped around the hysteroscopic balloon. (c) Placement of the hysteroscopic balloon stent under color ultrasound guidance. (d) Injection of 5 mL saline into the hysteroscopic balloon.
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case_images: After these procedures, an Interceed absorbable adhesion barrier (model 4530, Johnson & Johnson, USA) was wrapped around the uterine balloon stent (model ZJ-5, Jiangxi Xinnuo Bioengineering Co., Ltd., China) and inserted into the uterine cavity under ultrasound guidance, followed by the injection of 5 mL of saline to reduce bleeding and prevent adhesion (Figure 4).
case_images: Total removal of 38 submucosal uterine leiomyomas.
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case_images: A total of 38 uterine fibroids were successfully excised (Figure 5).
case_images: The lesion consisted of spindle-shaped smooth muscle cells in a woven pattern, with unclear borders, eosinophilic cytoplasm, cigar-like nuclei, and small nucleoli. Mitotic activity was low, as shown by hematoxylin & eosin (HE) staining.
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case_images: Postoperative pathology suggested typical uterine leiomyomas (Figure 6).
case_images: Hysteroscopic examination images. (a) Right uterine horn. (b) Left uterine horn. (c) Overall morphology of the uterine cavity. (d) Yellow flocculent material inside the uterine cavity, representing residual anti-adhesion film.
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case_images: At the uterine fundus, we discovered a yellowish mass-like substance, presumed to be residual anti-adhesion film, which was scraped out (Figure 7).