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Giant myomas of the uterus
International Journal of Gynecology and Obstetrics (2005) 88, 325 — 326
www.elsevier.com/locate/ijgo
BRIEF COMMUNICATION
Giant myomas of the uterus F. Inabaa,b,*, I. Maekawab, N. Inabaa a
Department of Obstetrics and Gynecology, Dokkyo University School of Medicine, Tochigi, Japan Division of Obstetrics and Gynecology, Numazu Municipal Hospital, Shizuoka, Japan
b
Received 1 September 2004; received in revised form 28 December 2004; accepted 28 December 2004
KEYWORDS Respiratory care; Differential diagnosis; Giant myoma
Uterine myomas weighing more than 11.3 kg are rarely seen in developed countries. Reported are here two patients in Japan with giant uterine myomas. A 41-year-old woman presented with an abdominal enlargement first noted 13 months earlier. Her arterial oxygen pressure was 77.4 mm Hg and oxygen saturation was 96.2 %. Serum tumor markers were normal. Computed tomography (CT) revealed a multilocular mass. A laparotomy was performed under general anesthesia. The tumor was a subserosal myoma node that compressed the diaphragm upward. The resected myoma node was 342723 cm and weighed 19.6 kg (Fig. 1). A 63-year-old woman who had been aware of an abdominal tumor for 14 years was transferred to
* Corresponding author. 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. Tel.: +81 282 87 2166, fax: +81 282 86 6856. E-mail address: [email protected] (F. Inaba).
our clinic. For religious reasons, she had refused to see a physician earlier. The patient was unconscious. Her blood pressure was 79/57 mm Hg, the heart rate was 36/min, and the pulse oxymeter saturation was 77% with 10 L/min of oxygen. Emergency CT scan revealed a huge abdominal mass that compressed the lungs and diaphragm upward. She fell suddenly into cardiac and respiratory arrest. Treatment was unsuccessful and the
Figure 1 Magnified photograph of the tumor of Case 1 before hysterectomy and excision. The tumor was a subserosal myoma derived from the posterior side of the uterine body.
0020-7292/$ - see front matter D 2005 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2004.12.026
326
Figure 2
F. Inaba et al.
Photograph of Case 2 before autopsy.
patient died. Autopsy revealed a huge myoma node that weighed 23.0 kg (Fig. 2). The bilateral lungs were greatly compressed and showed remarkable congestion. It is difficult to make a clinical diagnosis of giant myoma [1]. On ultrasonography, only those parts of the tumor that are close to the probe can be demonstrated clearly [2]. CT scan and magnetic resonance imaging (MRI) are informative only when the patient can enter into the respective machines. Pelvic angiography may detect the organ from which the tumor originates [3], although this method is not always available. Recently, a report was published in which a patient with a uterine myoma of 40 kg devel-
oped respiratory failure and required intensive preoperative respiratory care [4]. Thus it is necessary to pay attention to the patient’s respiratory care when a giant abdominal tumor is found. The compression of the lungs occurred secondarily to the patient’s generally poor condition. Moreover, giant pelvic tumors press on vena cava inferior, which must decrease the circulating blood volume. The striking contrast between these clinical courses was caused by the different respiratory status of the patients. Therefore, the key to successful preoperative treatment is appropriate respiratory care.
References [1] Pystynen P, Ylostalo P, Jarvinen PA. Preoperative differential diagnosis of solid and cystic gynecological tumors using onedimensional ultrasonic technique. Ann Chir Gynaecol Fenn 1968;57:153 – 6. [2] Sladkevicius P, Valentin L, Marsal K. Transvaginal Doppler examination for the differential diagnosis of solid pelvic tumors. J Ultrasound Med 1995;14:377 – 80. [3] Djelmis J, Mayer D, Majerovic M, Radanovic B, Starcevic V. Giant uterine leiomyoma devascularized by embolization prior to surgical removal. Eur J Obstet, Gynecol, Reprod Biol 2001;99:278 – 80. [4] Oelsner G, Elizur SE, Frenkel Y, Carp H. Giant uterine tumors: two cases with different clinical presentations. Obstet Gynecol 2003;101:1088 – 91.
www.elsevier.com/locate/ijgo
BRIEF COMMUNICATION
Giant myomas of the uterus F. Inabaa,b,*, I. Maekawab, N. Inabaa a
Department of Obstetrics and Gynecology, Dokkyo University School of Medicine, Tochigi, Japan Division of Obstetrics and Gynecology, Numazu Municipal Hospital, Shizuoka, Japan
b
Received 1 September 2004; received in revised form 28 December 2004; accepted 28 December 2004
KEYWORDS Respiratory care; Differential diagnosis; Giant myoma
Uterine myomas weighing more than 11.3 kg are rarely seen in developed countries. Reported are here two patients in Japan with giant uterine myomas. A 41-year-old woman presented with an abdominal enlargement first noted 13 months earlier. Her arterial oxygen pressure was 77.4 mm Hg and oxygen saturation was 96.2 %. Serum tumor markers were normal. Computed tomography (CT) revealed a multilocular mass. A laparotomy was performed under general anesthesia. The tumor was a subserosal myoma node that compressed the diaphragm upward. The resected myoma node was 342723 cm and weighed 19.6 kg (Fig. 1). A 63-year-old woman who had been aware of an abdominal tumor for 14 years was transferred to
* Corresponding author. 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. Tel.: +81 282 87 2166, fax: +81 282 86 6856. E-mail address: [email protected] (F. Inaba).
our clinic. For religious reasons, she had refused to see a physician earlier. The patient was unconscious. Her blood pressure was 79/57 mm Hg, the heart rate was 36/min, and the pulse oxymeter saturation was 77% with 10 L/min of oxygen. Emergency CT scan revealed a huge abdominal mass that compressed the lungs and diaphragm upward. She fell suddenly into cardiac and respiratory arrest. Treatment was unsuccessful and the
Figure 1 Magnified photograph of the tumor of Case 1 before hysterectomy and excision. The tumor was a subserosal myoma derived from the posterior side of the uterine body.
0020-7292/$ - see front matter D 2005 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2004.12.026
326
Figure 2
F. Inaba et al.
Photograph of Case 2 before autopsy.
patient died. Autopsy revealed a huge myoma node that weighed 23.0 kg (Fig. 2). The bilateral lungs were greatly compressed and showed remarkable congestion. It is difficult to make a clinical diagnosis of giant myoma [1]. On ultrasonography, only those parts of the tumor that are close to the probe can be demonstrated clearly [2]. CT scan and magnetic resonance imaging (MRI) are informative only when the patient can enter into the respective machines. Pelvic angiography may detect the organ from which the tumor originates [3], although this method is not always available. Recently, a report was published in which a patient with a uterine myoma of 40 kg devel-
oped respiratory failure and required intensive preoperative respiratory care [4]. Thus it is necessary to pay attention to the patient’s respiratory care when a giant abdominal tumor is found. The compression of the lungs occurred secondarily to the patient’s generally poor condition. Moreover, giant pelvic tumors press on vena cava inferior, which must decrease the circulating blood volume. The striking contrast between these clinical courses was caused by the different respiratory status of the patients. Therefore, the key to successful preoperative treatment is appropriate respiratory care.
References [1] Pystynen P, Ylostalo P, Jarvinen PA. Preoperative differential diagnosis of solid and cystic gynecological tumors using onedimensional ultrasonic technique. Ann Chir Gynaecol Fenn 1968;57:153 – 6. [2] Sladkevicius P, Valentin L, Marsal K. Transvaginal Doppler examination for the differential diagnosis of solid pelvic tumors. J Ultrasound Med 1995;14:377 – 80. [3] Djelmis J, Mayer D, Majerovic M, Radanovic B, Starcevic V. Giant uterine leiomyoma devascularized by embolization prior to surgical removal. Eur J Obstet, Gynecol, Reprod Biol 2001;99:278 – 80. [4] Oelsner G, Elizur SE, Frenkel Y, Carp H. Giant uterine tumors: two cases with different clinical presentations. Obstet Gynecol 2003;101:1088 – 91.