ArticleFrontiers in medicine2026
Submucosal uterine leiomyoma with complete cystic degeneration mimicking an empty gestational sac: a case report and literature review.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Uterine leiomyomas represent the most frequent benign pelvic tumors in women. Although various degenerative changes can occur, the complete cystic transformation of a submucosal leiomyoma-resulting in a large, fluid-filled intracavitary mass-is an exceptional clinical entity. Such presentations often pose diagnostic dilemmas by mimicking other conditions, notably an empty gestational sac. Case presentation: A 42-year-old parous woman (G3P2) presented with irregular vaginal bleeding lasting for 2 months, accompanied by recent-onset lower abdominal pain. Initial transvaginal ultrasonography demonstrated a large (65 mm × 45 mm) unilocular cystic lesion within the uterine cavity, raising the suspicion of an anembryonic pregnancy. Serial serum β-hCG testing yielded negative results. Subsequent hysteroscopy revealed a giant, smooth-walled cystic tumor originating from the posterior wall, which was entirely excised via electrosurgical resection. Preliminary histological evaluation indicated a mesenchymal neoplasm with focal proliferative features. A comprehensive immunohistochemical panel-showing positivity for SMA, Desmin, h-Caldesmon, CD10, and FH; negative 2SC; wild-type p53; a Ki-67 index near 5%; and scarce PHH3-positive cells-ultimately established the diagnosis of a completely degenerated cystic submucosal leiomyoma with focal proliferative activity. Follow-up imaging at 3 months confirmed the absence of recurrence. Conclusion: This case underscores that a completely cystic submucosal leiomyoma warrants consideration in the differential diagnosis of intracavitary cystic lesions, even when imaging findings are suggestive of an empty gestational sac. A negative serum β-hCG is a pivotal diagnostic clue. Hysteroscopy is invaluable for both direct visualization and therapeutic resection, while immunohistochemistry is essential for definitive diagnosis-particularly when initial histopathology is inconclusive.
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