Diagnostic Challenge: Distinguishing Uterine Fibroid with Cystic Degeneration vs. Ovarian Cystic Malignancy. A Case Report.

Our case is a 24-year-old woman who has had abdominal enlargement for eleven months. She had an abdominal mass with an elevated level of CA-125 and imaging studies showed a pelvic cystic mass with a solid part, and thus malignancy was considered in the differential diagnosis. A laparotomy myomectomy was performed. Postoperative histopathological examination results revealed no signs of malignancy. In this case, both ultrasonography and magnetic resonance imaging could not visualize both ovaries and the stalk of the pedunculated fibroid on the posterior uterine corpus. On physical examination and imaging, cystic degeneration of uterine fibroid may present like an ovarian mass. Preoperative diagnosis is challenging. A definitive diagnosis is only feasible postoperatively following histological examination.

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.