Akademik Veri Yönetim Sistemi
Türk Alman Jinekoloji Kongresi, Antalya, Türkiye, 23 - 27 Nisan 2025, cilt.1, sa.1, ss.46-48, (Tam Metin Bildiri)
Management of Apoplectic Leiomyoma in Pregnancy
Ömer Faruk Öz, Can Dinç, Cem Dağdelen, Tuğçe Tunç Acar,
Gizem Pınar, Selin Er
Akdeniz University, Faculty of Medicine
Myoma uteri, the most common solid tumor of the female
reproductive system, affects approximately 20–40% of women. Its growth is
estrogen-dependent, as evidenced by its tendency to regress during menopause
and enlarge during pregnancy. Although myomas are generally asymptomatic, their
presence during pregnancy has been associated with complications such as
spontaneous abortion, preterm birth, placental abruption, and increased risk of
cesarean delivery. Apoplectic leiomyoma, a rare pathological subtype, is
characterized by hemorrhage, hypercellularity, mitotic activity, nuclear
atypia, and necrosis, making it difficult to differentiate from leiomyosarcoma.
It has been linked to hormonal therapy and occurs in women of reproductive age,
particularly those using oral contraceptives, pregnant, or postpartum. A
36-year-old primiparous woman at 12 weeks and 3 days of gestation presented for
a routine pregnancy check-up. Ultrasound revealed a 6 × 4 cm uterine myoma in
the anterior corpus. During follow-up, she reported severe recurrent pelvic
pain. Despite recommendations for hospitalization and observation, she declined
inpatient care. Non-invasive prenatal testing (NIPT) results were normal, with
a fetal fraction rate of 3%. At 22 weeks and 4 days, ultrasound showed normal
fetal development and no increase in myoma size. However, the patient’s pain
had intensified. An MRI revealed a solid uterine lesion with red degeneration
or torsion, measuring 70 × 36 mm, with heterogeneous T2 hypo- and hyperintense
areas. The patient was hospitalized for pain management, receiving intravenous
and intramuscular analgesics. No contractions were detected on cardiotocography
(CTG), and fetal heart rate tracings were variable. She was discharged after
one week at her request. At 33 weeks and 6 days, she was admitted to the
emergency department with severe pelvic pain. She was hospitalized and treated
with analgesics. No uterine contractions or obstetric anomalies were detected
on ultrasound, and her transvaginal cervical length was 24 mm. Due to the risk
of preterm birth, antenatal corticosteroids were administered. The myoma
persisted without size changes but showed further degeneration. After 10 days,
the patient was discharged following pain relief and counseling on potential
obstetric complications. Subsequent weekly check-ups showed no changes in myoma
size or pain intensity. At 38 weeks and 1 day, the patient was again referred
to the emergency department for severe pain. CTG showed minimal irregular
contractions, and vaginal examination revealed no cervical dilatation.
Ultrasound confirmed normal fetal well-being and adequate amniotic fluid
levels. She was admitted for observation and pain management, with no further complications
beyond persistent pelvic pain. At 39 weeks and 4 days, the patient experienced
spontaneous rupture of membranes. She declined vaginal delivery and insisted on
a cesarean section to avoid labor pain. She and her husband were counseled on
the risks of cesarean delivery. In preparation for a possible intraoperative
myomectomy, erythrocyte suspension was arranged. A healthy 3,150-gram infant
was delivered via cesarean section. Following placental removal and hemostasis,
a myomectomy was performed without complications. Histopathological examination
confirmed the diagnosis of apoptotic leiomyoma. This case highlights the
significance of close monitoring and individualized management of myomas in
pregnancy to optimize maternal and fetal outcomes.
Keywords: Apoplectic myoma, pregnancy, hemorrhagic
degeneration, fibroma