Aim: To present a rare case of omental leiomyoma mimicking a subserosal uterine fibroid, highlighting its diagnostic challenges and management.Background: Leiomyomas are the most common benign tumors of the uterus, but extrauterine leiomyomas, particularly those arising from the omentum, are exceedingly rare.They may occur as parasitic leiomyomas or as primary omental smooth muscle tumors.Due to their location, they often mimic uterine fibroids clinically and radiologically, posing diagnostic and therapeutic challenges.Case description: A 40-year-old female, gravida 2 para 2, presented with heavy menstrual bleeding (11-12 fully soaked pads per day), lower abdominal pain, and fatigue.She had primary hypothyroidism controlled with levothyroxine.Clinical examination revealed mild pallor and a mobile infra-umbilical mass.Pelvic ultrasonography showed a vascular mass (5.6 5.5 5.2 cm) suggestive of a subserosal fibroid.A provisional diagnosis of symptomatic uterine leiomyoma was made.After optimization, she underwent hysteroscopy and laparoscopic myomectomy.Intraoperatively, three omental fibroids (largest 6 cm) with feeding vessels from the omentum were discovered, without attachment to the uterus.The uterine cavity was normal.Masses were excised laparoscopically and retrieved in an endo-bag.Postoperative recovery was uneventful, and histopathology confirmed benign leiomyomas.Conclusion: Omental leiomyomas are rare entities that may be mistaken for subserosal uterine fibroids.Definitive diagnosis is often made intraoperatively, with laparoscopy offering both diagnostic and therapeutic advantages.Histopathological examination remains mandatory to confirm benignity and exclude malignancy.Clinical significance: This case underlines the importance of considering extrauterine leiomyomas in the differential diagnosis of pelvic masses.Awareness of this entity can prevent intraoperative confusion and facilitate appropriate management.Laparoscopic excision with safe specimen retrieval ensures optimal outcomes, while reporting such cases enriches the limited global literature and guides future clinical practice.
Patle et al. (Fri,) studied this question.