A Giant Uterine Hydropic Leiomyoma with Distinctive Radiological Patterns: A Challenging Case and Literature Review
DOI:
https://doi.org/10.62177/apjcmr.v2i2.1222Keywords:
Hydropic Leiomyoma, Hydropic Degeneration, Radiological, Literature ReviewAbstract
Uterine hydropic leiomyoma is a rare condition. Only a few relevant cases have been reported until now. Distinguishing between uterine hydropic leiomyoma and other uterine malignancy tumors, such as leiomyosarcoma, using radiological-based methods is crucial. This can provide vital information on the inherent characteristics, facilitating clinical decision-making. We present a case report of a 42-year-old female patient diagnosed with a giant uterine hydropic leiomyoma with unique radiological characteristics. The patient recovered safely and remained in good condition after a successful surgical intervention.
Downloads
References
Mathew RP, Francis S, Jayaram V, Anvarsadath S. Uterine leiomyomas revisited with review of literature. Abdom Radiol (NY). 2021 Oct;46(10):4908-4926. doi: 10.1007/s00261-021-03126-4. DOI: https://doi.org/10.1007/s00261-021-03126-4
Munro MG. Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity. Fertil Steril. 2019 Apr;111(4):629-640. doi: 10.1016/j.fertnstert.2019.02.008. DOI: https://doi.org/10.1016/j.fertnstert.2019.02.008
Devereaux KA, Schoolmeester JK. Smooth Muscle Tumors of the Female Genital Tract. Surg Pathol Clin. 2019 Jun;12(2):397-455. doi: 10.1016/j.path.2019.02.004. DOI: https://doi.org/10.1016/j.path.2019.02.004
Wu X, Serna VA, Thomas J, Qiang W, Blumenfeld ML, Kurita T.. Subtype-specific tumor-associated fibroblasts contribute to the pathogenesis of uterine leiomyoma. Cancer Res 2017;77:6891–6901. DOI: https://doi.org/10.1158/0008-5472.CAN-17-1744
McCluggage WG, Singh N, Gilks CB. Key changes to the World Health Organization (WHO) classification of female genital tumours introduced in the 5th edition (2020). Histopathology. 2022 Apr;80(5):762-778. doi: 10.1111/his.14609. DOI: https://doi.org/10.1111/his.14609
Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Primers. 2016 Jun 23;2:16043. doi: 10.1038/nrdp.2016.43. DOI: https://doi.org/10.1038/nrdp.2016.43
McWilliams MM, Chennathukuzhi VM. Recent Advances in Uterine Fibroid Etiology. Semin Reprod Med. 2017 Mar;35(2):181-189. doi: 10.1055/s-0037-1599090. DOI: https://doi.org/10.1055/s-0037-1599090
Sparić R, Andjić M, Babović I, Nejković L, Mitrović M, Štulić J, et al. Molecular Insights in Uterine Leiomyosarcoma: A Systematic Review. Int J Mol Sci. 2022 Aug 27;23(17):9728. doi: 10.3390/ijms23179728. DOI: https://doi.org/10.3390/ijms23179728
Griffin BB, Ban Y, Lu X, Wei JJ. Hydropic leiomyoma: a distinct variant of leiomyoma closely related to HMGA2 overexpression. Hum Pathol. 2019 Feb;84:164-172. doi: 10.1016/j.humpath.2018.09.012. DOI: https://doi.org/10.1016/j.humpath.2018.09.012
Sun D, Yang P, Liu Y, Yu G. Fallopian tube lipoleiomyoma with degeneration: a case report and literature review. Int J Clin Exp Pathol. 2020 Aug 1;13(8):2163-2168.
Yorita K, Tanaka Y, Hirano K, Kai Y, Arii K, Nakatani K, et al. A subserosal, pedunculated, multilocular uterine leiomyoma with ovarian tumor-like morphology and histological architecture of adenomatoid tumors: a case report and review of the literature. J Med Case Rep. 2016 Dec 20;10(1):352. doi: 10.1186/s13256-016-1167-1. DOI: https://doi.org/10.1186/s13256-016-1167-1
Yorita K, Tanaka Y, Hirano K, Kuwahara M, Nakatani K, Fukunaga M, et al. Multilocular cystic leiomyoma of the anterolateral abdominal wall: A case report and literature review. Medicine (Baltimore). 2017 Dec;96(48):e8971. doi: 10.1097/MD.0000000000008971. DOI: https://doi.org/10.1097/MD.0000000000008971
Borella F, Mancarella M, Preti M, Mariani L, Stura I, Sciarrone A, et al. Uterine smooth muscle tumors: a multicenter, retrospective, comparative study of clinical and ultrasound features. Int J Gynecol Cancer. 2023 Dec 2:ijgc-2023-004880. doi: 10.1136/ijgc-2023-004880. DOI: https://doi.org/10.1136/ijgc-2023-004880
Patil AR, Nandikoor S, Padilu R. Hydropic degeneration of leiomyoma in nongravid uterus: The "split fiber" sign on magnetic resonance imaging. Indian J Radiol Imaging. 2018 Apr-Jun;28(2):182-186. doi: 10.4103/ijri.IJRI_214_17. DOI: https://doi.org/10.4103/ijri.IJRI_214_17
Lameira P, Filipe J, Cabeçadas J, Cunha TM. Hydropic leiomyoma: A radiologic pathologic correlation of a rare uterine tumor. Radiol Case Rep. 2022 Jun 27;17(9):3151-3156. doi: 10.1016/j.radcr.2022.06.008. DOI: https://doi.org/10.1016/j.radcr.2022.06.008
Yamaguchi T, Kyozuka H, Kochi Y, Ito F, Odajima H, Suzuki D, et al. Hydropic leiomyoma-like ovarian tumor: a case report. Fukushima J Med Sci. 2024 Apr 26;70(2):93-98. doi: 10.5387/fms.2023-22. DOI: https://doi.org/10.5387/fms.2023-22
Akkour K, Alhulwah M, Alqahtani N, Arafah MA. A Giant Leiomyoma with Massive Cystic Hydropic Degeneration Mimicking an Aggressive Neoplasm: A Challenging Case with a Literature Review. Am J Case Rep. 2021 Mar 31;22:e929085. doi: 10.12659/AJCR.929085. DOI: https://doi.org/10.12659/AJCR.929085
Horta M, Cunha TM, Oliveira R, Magro P. Hydropic leiomyoma of the uterus presenting as a giant abdominal mass. BMJ Case Rep. 2015 Sep 8;2015:bcr2015211929. doi: 10.1136/bcr-2015-211929. DOI: https://doi.org/10.1136/bcr-2015-211929
Awiwi MO, Badawy M, Shaaban AM, Menias CO, Horowitz JM, Soliman M, et al. Review of uterine fibroids: imaging of typical and atypical features, variants, and mimics with emphasis on workup and FIGO classification. Abdom Radiol (NY). 2022 Jul;47(7):2468-2485. doi: 10.1007/s00261-022-03545-x. DOI: https://doi.org/10.1007/s00261-022-03545-x
Kamra HT, Dantkale SS, Birla K, Sakinlawar PW, Narkhede RR. Myxoid leiomyoma of cervix. J Clin Diagn Res. 2013 Dec;7(12):2956-7. doi: 10.7860/JCDR/2013/6171.3805. DOI: https://doi.org/10.7860/JCDR/2013/6171.3805
Gockley AA, Rauh-Hain JA, del Carmen MG. Uterine leiomyosarcoma: a review article. Int J Gynecol Cancer. 2014 Nov;24(9):1538-42. doi: 10.1097/IGC.0000000000000290. DOI: https://doi.org/10.1097/IGC.0000000000000290
Shinya T, Shibamoto K, Maeba K, Kato K, Monobe Y, Fujiwara M, et al. Magnetic resonance imaging findings of a myxoid leiomyosarcoma of the uterus: A case report and literature review. Eur J Radiol Open. 2021 Feb 3;8:100328. doi: 10.1016/j.ejro.2021.100328. DOI: https://doi.org/10.1016/j.ejro.2021.100328
DeMulder D., Ascher S.M. Uterine leiomyosarcoma: Can MRI differentiate leiomyosarcoma from benign leiomyoma before treatment? Am. J. Roentgenol. 2018;211(6):1405–1415. doi: 10.2214/AJR.17.19234. DOI: https://doi.org/10.2214/AJR.17.19234
Lin Y, Wu RC, Huang YL, Chen K, Tseng SC, Wang CJ, et al. Uterine fibroid-like tumors: spectrum of MR imaging findings and their differential diagnosis. Abdom Radiol (NY). 2022 Jun;47(6):2197-2208. doi: 10.1007/s00261-022-03431-6. DOI: https://doi.org/10.1007/s00261-022-03431-6
Wang C, Zheng X, Zhou Z, Shi Y, Wu Q, Lin K. Differentiating cellular leiomyoma from uterine sarcoma and atypical leiomyoma using multi-parametric MRI. Front Oncol. 2022 Oct 6;12:1005191. doi: 10.3389/fonc.2022.1005191. DOI: https://doi.org/10.3389/fonc.2022.1005191
Aminzadeh P, Alibrahim E, Dobrotwir A, Paul E, Goergen S. Multiparametric MR evaluation of uterine leiomyosarcoma and STUMP versus leiomyoma in symptomatic women planned for high frequency focussed ultrasound: accuracy of imaging parameters and interobserver agreement for identification of malignancy. Br J Radiol. 2021 Mar 1;94(1119):20200483. doi: 10.1259/bjr.20200483. DOI: https://doi.org/10.1259/bjr.20200483
Kim TH, Kim JW, Kim SY, Kim SH, Cho JY. What MRI features suspect malignant pure mesenchymal uterine tumors rather than uterine leiomyoma with cystic degeneration? J Gynecol Oncol. 2018 May;29(3):e26. doi: 10.3802/jgo.2018.29.e26. DOI: https://doi.org/10.3802/jgo.2018.29.e26
Lai PH, Ding DC. Retroperitoneal Hydropic Leiomyoma Mimicking an Ovarian Cyst. Case Rep Obstet Gynecol. 2022 Aug 4;2022:2012376. doi:10.1155/2022/2012376. DOI: https://doi.org/10.1155/2022/2012376
Oguma T, Yamasaki N, Nakanishi K, Kinoshita D, Mitsuhashi T, Nakagawa S.Pseudo-Meigs' syndrome associated with hydropic degenerating uterine leiomyoma:a case report. J Obstet Gynaecol Res. 2014 Apr;40(4):1137-40. doi:10.1111/jog.12299. DOI: https://doi.org/10.1111/jog.12299
Heffernan E, Köbel M, Spielmann A. Case report: Hydropic leiomyoma of theuterus presenting in pregnancy: imaging features. Br J Radiol. 2009 Aug;82(980):e164-7. doi: 10.1259/bjr/50866065. DOI: https://doi.org/10.1259/bjr/50866065
Rio G, Lima M, Gil R, Horta M, Cunha TM. T2 hyperintense myometrial tumors: can MRI features differentiate leiomyomas from leiomyosarcomas? Abdom Radiol (NY). 2019 Oct;44(10):3388-3397. doi: 10.1007/s00261-019-02097-x. DOI: https://doi.org/10.1007/s00261-019-02097-x
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2026 Yongliang Li, Chengying Ou, Wanlin Dong, Yuge Xu, Hua Wei

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
DATE
Accepted: 2026-03-26
Published: 2026-04-07








