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Large pelvic mass in a 46-year-old woman

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References

Diagnosis: Uterine fibroid

A uterine fibroid, also known as a leiomyoma, is a benign tumor that is composed of smooth muscle tissue and fibrous connective tissue. It is the most common pelvic tumor found in the female body.1 Unlike cancerous tumors, fibroids usually grow slowly and do not break away or invade other parts of the body. Patients can have a single fi- broid or multiple fibroids varying in size and location.1

Fibroids tend to affect women of a certain age. Approximately one in 3 women develops fibroids, and those between the ages of 30 and 40 are at greatest risk.1,2 Estrogen, growth hormone, and progesterone affect the growth rate of these tumors. Fibroids— especially very small ones—are usually asymptomatic, but can cause symptoms as they enlarge. Typical patient complaints in- clude lower abdominal pain, menorrhagia (with anemia), dysmenorrhea, and abnormal uterine bleeding.2,3

A growing fibroid may outpace its blood supply. The result: various forms of degeneration, including hyaline or myxoid degeneration, calcification, cystic degeneration, and red degeneration (infarction of fibroid during pregnancy).

Based on its position within the uterus, a fibroid can be submucosal, intramural, or subserosal. Uterine fibroids are usually diagnosed based on a clinical history and pelvic examination; the presence of a fibroid is confirmed by ultrasound, magnetic resonance imaging (MRI), computed tomography, saline infusion sonography, or hysterosalpingography.4

Is it a fibroid or a uterine sarcoma?
A rapidly growing uterine mass is not a reliable indicator of a uterine sarcoma in a woman of reproductive age.5 However, rapid tumor growth in a menopausal woman who is not on hormonal replacement therapy may be an indicator of uterine sarcoma.5

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