A giant symptomatic primary ovarian leiomyoma with prominent necrosis and degenerative changes in a 75-year-old female: a case report.

backgroundAdnexal masses represent a prevalent gynecological condition that may affect females of any age, although particularly those of reproductive age. These masses can be classified as either physiological or neoplastic, with the majority of adnexal neoplasms being benign. Primary ovarian leiomyoma is an exceedingly rare type of extrauterine leiomyomas, Its occurrence rate accounts for approximately 0.5-1% of all benign smooth muscle tumors found in the ovaries. These tumors are mostly asymptomatic, unilateral, non-malignant, often measuring less than 3 cm in size, and tend to be reported in women aged 20-65 years, with a considerably higher incidence in premenopausal women compared with postmenopausal women. These tumors lack distinguishing clinical features, thereby requiring comprehensive preoperative and postoperative investigations to avoid confusion with other differential diagnoses. CASE PRESENTATION: A 75-year-old gravida 5 para 5 Syrian female reported abdominal pain, heaviness, mild vaginal bleeding, and frequent urination. She had a history of well-controlled hypertension. Physical examination identified a large abdominopelvic mass, and subsequent imaging modalities demonstrated a 24 cm × 15.5 cm mass with notable cystic components. Following adequate preoperative assessment, a total hysterectomy and bilateral salpingo-oophorectomy were performed. Microscopic study of the resected mass revealed findings suggestive of primary ovarian leiomyoma with no cell atypia, and subsequent immunohistochemical staining corroborated the diagnosis. Mitotic activity was scant, thereby excluding malignancy, and the diagnosis of primary ovarian leiomyoma was established (please refer to the graphical abstract).

conclusionThis case highlights the importance of considering ovarian tumors in elderly females with a palpable abdominopelvic mass. Primary ovarian leiomyoma should not be excluded on the basis of the age of the patient. The definitive diagnosis remains dependent on postoperative histological evaluation. Leiomyosarcoma should be excluded in cases of large ovarian tumors, particularly in postmenopausal women, regardless of their benign features on microscopic examination.