A Case of Large Uterine Myoma in a 14-Year-Old Girl

Background: Uterine myomas are the most common tumors of the female genital tract; they are mesenchymal tumors that arise from smooth-muscle cells and extracellular matrix of the uterus. They are less common in adolescents than in adults, and their clinical presentation is usually represented by abdominal/ back pain, menstrual disorders, and vaginal bleeding. Case: The case report is described of a 14-year-old girl who presented to our Institution with the chief complaint of menstrual disorders (menorrhagia), and abdominal and back pain. The abdominal examination revealed a large mass extending 3 cmabove the umbilical-transverse line. Abdominal ultrasound and magnetic resonance imaging (MRI) confirmed the presence of a mass that originated from the myometrium of the posterior uterine wall. The patient received an intramuscular injection of leuprolide acetate (3.75 mg, Decapeptyl, Ipsen, Rome, Italy) in order to reduce the volume of the mass before surgery and to decrease the intraoperative blood loss. Twenty-two (22) days after the first injection of leuprolide, the patient was admitted again to our Department because of fever and intense abdominal pain of increasing severity. Microscopic examination, immunohistochemical and the cytological examination of the fluid found in the pouch of Douglas during surgery confirmed the benign nature of the uterine mass, hypothesized through clinical and imaging examinations. Results: At 2-year follow-up, no recurrence of myoma was observed. Conclusions: Large uterine myomas may be diagnosed in adolescents. Before surgery, combining ultrasonography with MRI permits precise information to be obtained on the nature of the mass. Fertility sparing and low surgical injury are mandatory in this population.