Giant pedunculated subserosal myoma and the performance of the endovascular approach for uterine preservation in a nulliparous patient. Case report

Abstract

The endovascular approach of selective embolization of the uterine arteries plays a fundamental role as a treatment for uterine myomatosis and nulliparous women who wish to preserve their uterus. However, its performance will depend on the location, size, and imaging characteristics of
the fibroid to be evaluated. The objective is to present uterine artery embolization as a therapeutic option for the management of large uterine myomas and satisfactory follow-up with contrastenhanced magnetic resonance imaging based on our experience with a clinical case. We report the case of a 45-year-old female patient who presented with hypogastric pain, metrorrhagia, and
an increase in abdominal volume over the pelvic region. Imaging studies showed an enlarged uterus with diameters of 20 x 17.8 x 22.7 cm, a volume of 4220 cc, and myomatous formations, the most dominant of which was subserosal, pedunculated, right-sided, 15 cm in size, and with a 4 cm
pedicle. Based on the above, a diagnosis of symptomatic giant uterine myomatosis was made, and hysterectomy was proposed as definitive management. However, due to the desire to preserve the uterus, endovascular therapy with selective embolization of the uterine arteries was proposed. At the 3-month follow-up, the patient reported significant improvement in pain, metrorrhagia, and the feeling of heaviness in the pelvic region. After 6 months, imaging was performed, showing a decrease in uterine size (2500 cc), allowing a 41 % reduction from the baseline volume. A follow-up was performed after one year with no changes in relation to the symptoms described.