Severe chronic pelvic pain due to cystic degeneration of subserosal uterine fibroid with type 2 diabetes and obesity: Serial case report.

INTRODUCTION AND IMPORTANCE: Uterine fibroids, benign tumors of the myometrium, can cause pelvic pain. Obesity and diabetes mellitus can increase the risk of developing fibroid. We present two cases of uterine fibroid, diabetes mellitus, and obesity with moderate-to-severe chronic pain. CASE PRESENTATION: The first case is a 37-year-old woman with pelvic pain and a subserosal uterine fibroid, primary infertility, grade 2 obesity, and diabetes mellitus. Pathologic examination revealed smooth muscle cells with degeneration sites. The second case is a 35-year-old nulliparous woman with abdominal enlargement, lower abdominal pain, diabetes mellitus, and morbid obesity. Ultrasonography showed a large uterus with a hyperechoic mass and cystic degeneration. Histopathological examination revealed leiomyoma. CLINICAL DISCUSSION: Our patient's chronic pelvic pain may be caused by its large size. Excess adipose tissue in obesity may result in the formation of estrone, causing the proliferation of fibroids. A subserous fibroid is less likely to cause infertility; thus, a myomectomy was performed to relieve pain. Obesity and diabetes could interfere with patients' periods. Higher levels of insulin and fat tissue induce androgen production. Increased estrogen levels lead to alteration of gonadotropin production, menstrual abnormalities, and ovulatory dysfunction. CONCLUSION: Cystic degeneration of the subserous uterine fibroid could induce pain though it rarely affects fertility. A myomectomy was conducted to relieve pain. Comorbid diseases such as diabetes mellitus and obesity can lead to cystic degeneration of the uterine fibroid.

Rare case of pelvic schwannoma mimicking intra-ligamenter uterine fibroid: A case report.

INTRODUCTION AND IMPORTANCE: Schwannomas are benign tumors originating from Schwann cells of nerve fibers. Pelvic schwannomas are extremely rare. Here, we present a case of a 48-year-old woman with a pelvic schwannoma imitating degenerating cystic leiomyoma. CASE PRESENTATION: A 48-year-old woman presented with brown-yellowish bloody vaginal discharge, fever, abdominal enlargement, and pain. Abdominal ultrasound showed a homogeneous solid mass with a clear border separated from the uterus and left ovary. Computed tomography (CT) scan revealed a multilocular cystic mass with thick septa and solid enhancing component. Histopathological examination showed a mesenchymal tumor composed of cells with fine chromatin. The nuclei were oval or round, and some cells exhibited spindle and cigar-shaped nuclei. Tumor cells had an abundant amount of eosinophilic cytoplasm. Immunohistochemical examination demonstrated positive expression for S100 as specific staining for schwannomas. Mitosis was not found, and hyalinized blood vessels were observed. CLINICAL DISCUSSION: Compression by the tumor into the surrounding organs, such as the bladder and intestines, could cause difficulty with defecation and urination in patients. The absence of specific signs and symptoms can lead to a misdiagnosis of pelvic schwannoma. Surgery is the treatment of choice. It is difficult to establish a definitive diagnosis before surgery. Laparotomy approach was taken and a histopathological examination was completed to confirm the diagnosis. CONCLUSION: Unspecified pelvic pain with abdominal mass may suggest a rare tumor such as schwannoma. Transvaginal ultrasonography is incapable of reliably distinguishing between schwannoma and other tumors.