Huge angioleiomyoma of the uterus, suspected to be an ovarian tumor: a case report

Angioleiomyoma of the uterus is an extremely rare benign tumor and a variant of uterine leiomyoma. In this study, a case of uterine angioleiomyoma was initially mistaken for an ovarian tumor. However, it was successfully surgically managed, and histology revealed the pathology. A 33-year-old Nigerian female patient, nullipara with phocomelia, presented with a complaint of abdominal discomfort of 15 years and abdominal swelling of 5-year duration. The abdomen was distended on examination to about 40 weeks’ size. Abdominopelvic ultrasound and computed tomography scans suspected right ovarian malignancy. Cancer antigen 125 was elevated at 189U/mL (normal < 35U/mL). She had a laparotomy for suspected ovarian malignancy with excision of the abdominal mass. Intraoperative findings were ascitic fluid of 15 L and a huge cystic multi-septate mass measuring 30 cm × 26 cm, which weighed 6 kg and was attached to the fundus of the uterus by a stalk. Hysterectomy was not carried out because she was nullipara, and the uterus with its appendages appeared normal. Histopathology revealed uterine angioleiomyoma. Her postoperative recovery was satisfactory, and there has been no recurrence of symptoms. Uterine angioleiomyoma is a rare benign tumor, originating from the mesenchymal tissue and composed of smooth muscle cells and thick-walled vessels of the uterus. The diagnosis of uterine angioleiomyoma is not always possible, as large‑sized lesions may predominantly mask other pelvic structures and make it difficult to visualize the ovaries, thereby mimicking an ovarian tumor, as seen in our case. The choice of treatment is surgical excision of the mass, which was done for this patient. Although uterine angioleiomyoma is rare, it should be suspected if radiological investigation reveals a multilobulated mass with solid, cystic, and multi-septal content in middle-aged women. The good outcome further strengthens the role of proper surgical care and follow-up histology in patients with symptomatic gynecological abdominal tumors.