Large uterine pyomyoma in a perimenopausal female: A case report and review of 50 reported cases in the literature

Iwahashi,Naoyuki; Mabuchi,Yasushi; Shiro,Michihisa; Yagi,Shigetaka; Minami,Sawako; Ino,Kazuhiko

doi:10.3892/mco.2016.1005

Large uterine pyomyoma in a perimenopausal female: A case report and review of 50 reported cases in the literature

Authors:
- Naoyuki Iwahashi
- Yasushi Mabuchi
- Michihisa Shiro
- Shigetaka Yagi
- Sawako Minami
- Kazuhiko Ino
View Affiliations

Affiliations: Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641‑0012, Japan
Published online on: August 26, 2016 https://doi.org/10.3892/mco.2016.1005
Pages: 527-531
Copyright: © Iwahashi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Pyomyoma is a rare complication, which withoug antibiotics or surgical intervention, may cause sepsis and mortality. The present study reported a case of large uterine pyomyoma in a perimenopausal female. A 53‑year‑old multigravida woman was referred to the Department of Obstetrics and Gynecology (Wakayama Medical University, Wakayama, Japan) due to progressive abdominal distension. The patient presented with anemia gravis, severe inflammatory reaction and cachexia. Computed tomography revealed a large unilocular mass, 50 cm in size, with an irregular surface and thickened wall, occupying the entire abdomen. Following antibiotic medication, the patient underwent a total abdominal hysterectomy and bilateral salpingo‑oophorectomy. Intraoperative findings demonstrated a solid tumor arising from the back of the uterine body. A total of 12 liters of purulent, malodorous fluid was drained from the tumor. The resected mass was 50 cm in size and 13.5 kg in weight. Cultures of the pus revealed the presence of Streptococcus agalactiae. Pathological findings revealed suppurative leiomyoma with no malignancy. Large pyomyoma is difficult to distinguish from a gynecological malignant tumor types, particularly in perimenopausal women with non‑specific clinical presentation. Although pyomyoma is a benign tumor, care must be taken to discriminate these from large abdominal tumors.

View Figures

View References

1	Mason TC, Adair J and Lee YC: Postpartum pyomyoma. J Natl Med Assoc. 97:826–828. 2005.PubMed/NCBI
2	Kobayashi F, Kondoh E, Hamanishi J, Kawamura Y, Tatsumi K and Konishi I: Pyomayoma during pregnancy: A case report and review of the literature. J Obstet Gynaecol Res. 39:383–389. 2012. View Article : Google Scholar : PubMed/NCBI
3	Miller I: Suppurating fibromyomas. Report of a case with a review of the literature. Am J Obstet Gynecol. 50:522–526. 1945.
4	Kaufmann BN, Cooper VM and Cookson P: Clostridium perfringens septicemia complicating degenerating uterine leiomyomas. Am J Obstet Gynecol. 118:877–878. 1974. View Article : Google Scholar : PubMed/NCBI
5	Greenspoon JS, Ault M, James BA and Kaplan L: Pyomyoma associated with polymicrobial bacteremia and fatal septic shock: Case report and review of the literature. Obstet Gynecol Surv. 45:563–569. 1990. View Article : Google Scholar : PubMed/NCBI
6	Chen JR, Yang TL, Lan FH and Lin TW: Pyomyoma mimicking advanced ovarian cancer: A rare manifestation in a postmenopausal virgin. Taiwan J Obstet Gynecol. 53:101–103. 2014. View Article : Google Scholar : PubMed/NCBI
7	Manchana T, Sirisabya N, Triratanachat S, Niruthisard S and Tannirandorn Y: Pyomyoma in a perimenopausal woman with intrauterine device. Gynecol Obstet Invest. 63:170–172. 2007. View Article : Google Scholar : PubMed/NCBI
8	Kitamura Y, Ascher SM, Cooper C, Allison SJ, Jha RC, Flick PA and Spies JB: Imaging manifestations of complications associated with uterine artery embolization. Radiographics. 25:(Suppl 1). S119–S132. 2005. View Article : Google Scholar : PubMed/NCBI
9	Abulafia O, Shah T, Salame G, Miller MJ, Serur E, Zinn HL, Sokolovski M and Sherer DM: Sonographic features associated with post-uterine artery embolization pyomyoma. J Ultrasound Med. 29:839–842. 2010.PubMed/NCBI
10	Shukla PA, Kumar A, Klyde D and Contractor S: Pyomyoma after uterine artery embolization. J Vasc Interv Radiol. 23:423–424. 2012. View Article : Google Scholar : PubMed/NCBI
11	Pinto E, Trovão A, Leitão S, Pina C, Mak Fk and Lanhoso A: Conservative laparoscopic approach to a perforated pyomyoma after uterine artery embolization. J Minim Invasive Gynecol. 19:775–779. 2012. View Article : Google Scholar : PubMed/NCBI
12	Rosen ML, Anderson ML and Hawkins SM: Pyomyoma after uterine artery embolization. Obstet Gynecol. 121:(2 Pt 2 Suppl 1). S431–S433. 2013.
13	Weiss G, Shenker L and Gorstein F: Suppurating myoma with spontaneous drainage through abdominal wall. N Y State J Med. 76:572–573. 1976.PubMed/NCBI
14	Genta PR, Dias ML, Janiszewski TA, Carvalho JP, Arai MH and Meireles LP: Streptococcus agalactiae endocarditis and giant pyomyoma stimulating ovarian cancer. South Med J. 94:508–511. 2001. View Article : Google Scholar : PubMed/NCBI
15	Fletcher H, Gibson R, Williams N, Wharfe G, Nicholson A and Soares D: A woman with diabetes presenting with pyomyoma and treated with subtotal hysterectomy: A case report. J Med Case Rep. 3:74392009. View Article : Google Scholar : PubMed/NCBI
16	Ono H, Kanematsu M, Kato H, Toyoki H, Hayasaki Y, Furui T, Morishige K and Hatano Y: MR imaging findings of uterine pyomyoma: Radiologic-pathologic correlation. Abdom Imaging. 39:797–801. 2014. View Article : Google Scholar : PubMed/NCBI
17	Goyal S, Mohan H, Punia RS and Tandon R: Subserosal pyomyoma and tubo-ovarian abscess in a diabetic patient. J Obstet Gynaecol. 35:101–102. 2015. View Article : Google Scholar : PubMed/NCBI
18	Lee SR, Kim BS and Moon HS: Magnetic resonance imaging and positron emission tomography of a giant multiseptated pyomyoma simulating an ovarian cancer. Fertil Steril. 94:1900–1902. 2010. View Article : Google Scholar : PubMed/NCBI
19	Bedrosian L, Gabriels AG Jr and Hengerer AD: Ruptured suppurating myoma; a surgical emergency. Am J Obstet Gynecol. 71:1145–1147. 1956. View Article : Google Scholar : PubMed/NCBI
20	Fuller AF Jr and Lawrence WD: Case records of the Massachusetts General Hospital. Case 23-1985. N Engl J Med. 312:1505–1511. 1985.PubMed/NCBI
21	Yang CH and Wang CK: Edwardsiella tarda bacteraemia-complicated by acute pancreatitis and pyomyoma. J Infect. 38:124–126. 1999. View Article : Google Scholar : PubMed/NCBI
22	Gupta B, Sehgal A, Kaur R and Malhotra S: Pyomyoma: A case report. Aust N Z J Obstet Gynecol. 39:520–521. 1999. View Article : Google Scholar
23	Sah SP, Rayamajhi AK and Bhadani PP: Pyomyoma in a postmenopausal woman: A case report. Southeast Asian J Trop Med Public Health. 36:979–981. 2005.PubMed/NCBI
24	Yeat SK, Chong KM, Pan HS, Cheng WC, Hwang JL and Lee CC: Impending sepsis due to a ruptured pyomyoma with purulent peritonitis: A case report and literature review. Taiwan J Obstet Gynecol. 44:75–79. 2005. View Article : Google Scholar
25	Patwardhan A and Bulmer P: Pyomyoma as a complication of uterine fibroids. J Obstet Gynaecol. 27:444–445. 2007. View Article : Google Scholar : PubMed/NCBI
26	Chen ZH, Tsai HD and Sun MJ: Pyomyoma: A rare and life-threatening complication of uterine leiomyoma. Taiwan J Obstet Gynecol. 49:351–356. 2010. View Article : Google Scholar : PubMed/NCBI
27	Kuriyama K, Makiishi T, Maeda S, Konishi T and Hirose K: Acute bilateral renal cortical necrosis complicating pyomyoma. Intern Med. 49:511–512. 2010. View Article : Google Scholar : PubMed/NCBI
28	Zangeneh M, Alsadat Mahdavi A, Amini E, Davar Siadat S and Karimian L: Pyomyoma in a premenopausal woman with fever of unknown origin. Obstet Gynecol. 116:(Suppl 2). S526–S528. 2010. View Article : Google Scholar
29	Liu HS and Chen CH: Subserosal pyomyoma in a virgin female: Sonographic and computed tomographic imaging features. Ultrasound Obstet Gynecol. 37:247–248. 2011. View Article : Google Scholar : PubMed/NCBI
30	Wong TC, Bard DS and Pearce LW: Unusual case of IUD associated postabortal sepsis complicated by an infected necrotic leiomyoma, suppurative pelvic thrombophlebitis, ovarian vein thrombosis, hematoperitoneum and drug fever. J Ark Med Soc. 83:138–147. 1986.PubMed/NCBI
31	Karcaaltincaba M and Sudakoff GS: CT of a ruptured pyomyoma. AJR Am J Roentgenol. 181:1375–1377. 2003. View Article : Google Scholar : PubMed/NCBI
32	Nguyen QH and Gruenewald SM: Sonographic appearance of a postpartum pyomyoma with gas production. J Clin Ultrasound. 36:186–188. 2008. View Article : Google Scholar : PubMed/NCBI
33	Stroumsa D, Ben-David E, Hiller N and Hochner-Celnikier D: Severe clostridial pyomyoma following an abortion does not always require surgical intervention. Case Rep Obstet Gynecol. 2011:3646412011.PubMed/NCBI