Abstract:

Objective: To improve the diagnosis and treatment of diffuse uterine leiomyomatosis (DUL). Methods: 33 cases of DUL admitted between January 2009 and October 2022 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University were analyzed retrospectively, including their clinical characteristics, diagnosis and treatment methods and postoperative pregnancy. Results: The average age of onset of the 33 patients was (38.4±6.9) years (24-52 years). Nineteen patients (57.6%) presented with menorrhagia, 7 patients (21.2%) presented with frequent urination or lower abdominal distension, and the remaining 7 patients (21.2%) were asymptomatic and the examination revealed the uterine leiomyoma was progressively enlarged. Ultrasound examination was performed in 33 patients, and 15 patients(45.5%) showed myometrium was full of hypoechoic nodules. 7 patients underwent magnetic resonance imaging (MRI), and 3 cases showed diffuse distribution of round nodules or masses of variable sizes in the myometrium. All 33 patients underwent surgical treatment, 19 underwent transabdominal or laparoscopic hysterectomy, the other 14 with fertility requirements, 11 of them underwent transabdominal myomectomy and 3 underwent hysteroscopic myomectomy. Postoperative pathology and immunohistochemistry were all suggestive of leiomyoma. The average follow-up time after surgery was (67.8±36.3) months in 14 patients with fertility requirements (2 patients lost). Three patients had natural pregnancies, two had successful deliveries (one of which had two deliveries), and the other had cornual pregnancy that was cleared. Conclusions: DUL is a rare benign smooth muscle tumor that occurs in women of reproductive age. The most common clinical symptoms were menorrhagia and infertility. If ultrasound shows myometrium was full of myoma nodules and the patient presents with menorrhagia or infertility except for other reasons, MRI is indicated to help identify the disease early stage. Surgery is the main treatment. Hysterectomy is recommended for patients without fertility requirements, and the choice of fertility-preserving treatment requires further research.

Key words: Uterus, Leiomyomatosis, Diagnosis, Therapy, Pregnancy outcome