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Giant cervical uterine leiomyoma associated with bilateral ureterohydronephrosis and retroperitoneal perinephric urinoma at the left kidney: A case report and

  • Authors:
    • Anna Thanasa
    • Efthymia Thanasa
    • Emmanouil Xydias
    • Apostolos Ziogas
    • Ioannis Thanasas
  • View Affiliations / Copyright

    Affiliations: Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece, Department of Obstetrics and Gynaecology, EmbryoClinic IVF, 55133 Thessaloniki, Greece, Department of Medicine, University of Thessaly, School of Health Sciences, 41334 Larissa, Greece, Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
    Copyright: © Thanasa et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 57
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    Published online on: July 28, 2025
       https://doi.org/10.3892/mi.2025.256
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Abstract

The present case report describes the successful surgical treatment of a rare case of a giant cervical leiomyoma of the uterus associated with bilateral ureterohydronephrosis and the formation of a retroperitoneal perinephric urinoma in the left kidney. A 51‑year‑old patient presented with urinary retention, constipation, and lower abdominal pain radiating mainly to the lumbar region. A clinical examination revealed a small amount of vaginal bleeding, with the uterine fundus palpable ~2 cm below the navel. Imaging with computed tomography and magnetic resonance imaging revealed the presence of a giant cervical leiomyoma of the uterus occupying the entire pelvis, causing compressive effects on the ureters, resulting in bilateral ureterohydronephrosis and the formation of a retroperitoneal urinoma at the level of the left kidney. Tumor markers were negative. It was decided to perform a total abdominal hysterectomy with bilateral salpingo‑oophorectomy. The hysterectomy was technically difficult, and the traumatic rupture of the bladder was unavoidable. Surgical drainage of the urinoma was not deemed necessary. The urologists recommended monitoring of the lesion and the post‑operative retention of ureteral stents to manage the dilations of the pelvicalyceal system. A histopathological examination of the surgical specimen confirmed the diagnosis of cervical leiomyoma of the uterus. The post‑operative course was smooth. Urination was restored without issues following the removal of the urinary catheter. The ureteral stents were removed at 3 months after the surgery, at which time point, the ultrasound examination of the urinary system revealed the complete restoration of the morphology of the kidneys. After the detailed description of this rare case, particular emphasis is placed on the challenging preoperative diagnostic approach and the significant intraoperative difficulties in the effective surgical management of giant cervical leiomyomas of the uterus to ensure the best postoperative outcome.
View Figures

Figure 1

Image obtained during the vaginal
examination of the patient, the obliterated and displaced cervix
(yellow arrow) supported the presence of a giant endocervical
fibroid.

Figure 2

Computed tomography imaging of a giant
endocervical fibroid associated with bilateral
ureterohydronephrosis and retroperitoneal perinephric urinoma. (A)
A large, solid, hyperechoic mass with clear borders (red arrows)
occupying the pelvis and compressing adjacent anatomical
structures. (B) Bilateral dilation of the pelvicalyceal system
(blue arrows) and extravasation of contrast material into the left
kidney, corresponding to a retroperitoneal perinephric urinoma
(green arrow).

Figure 3

MRI imaging of a well-defined pelvic
mass (red arrows) originating from the endocervix corresponding to
a giant endocervical fibroid.

Figure 4

Intraoperative imaging of a giant
endocervical fibroid: The presence of the tumor is evident, which
is firmly adhered to the adjacent anatomical structures and arises
from the isthmus of the uterus at the level of the scars from
previous cesarean sections (white arrows), occupying the entire
pelvis.

Figure 5

Histological image of a cervical
fibroid. (A) Depiction of smooth borders with the absence of
mitosis and atypia (hematoxylin and eosin staining; magnification,
x40; scale bar, 100 µm). (B) Vascular congestion with focal
hemorrhagic infiltration of the stroma (hematoxylin and eosin
staining; magnification, x40; scale bar, 100 µm).

Figure 6

Post-operative ultrasound examination
of the urinary system, revealing normal kidney morphology without
the pre-operative dilatation of the pyelocaliceal system and the
presence of the perinephric urinoma; (A) right kidney, (B) left
kidney.
View References

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Copy and paste a formatted citation
Spandidos Publications style
Thanasa A, Thanasa E, Xydias E, Ziogas A and Thanasas I: Giant cervical uterine leiomyoma associated with bilateral ureterohydronephrosis and retroperitoneal perinephric urinoma at the left kidney: A case report and. Med Int 5: 57, 2025.
APA
Thanasa, A., Thanasa, E., Xydias, E., Ziogas, A., & Thanasas, I. (2025). Giant cervical uterine leiomyoma associated with bilateral ureterohydronephrosis and retroperitoneal perinephric urinoma at the left kidney: A case report and. Medicine International, 5, 57. https://doi.org/10.3892/mi.2025.256
MLA
Thanasa, A., Thanasa, E., Xydias, E., Ziogas, A., Thanasas, I."Giant cervical uterine leiomyoma associated with bilateral ureterohydronephrosis and retroperitoneal perinephric urinoma at the left kidney: A case report and". Medicine International 5.5 (2025): 57.
Chicago
Thanasa, A., Thanasa, E., Xydias, E., Ziogas, A., Thanasas, I."Giant cervical uterine leiomyoma associated with bilateral ureterohydronephrosis and retroperitoneal perinephric urinoma at the left kidney: A case report and". Medicine International 5, no. 5 (2025): 57. https://doi.org/10.3892/mi.2025.256
Copy and paste a formatted citation
x
Spandidos Publications style
Thanasa A, Thanasa E, Xydias E, Ziogas A and Thanasas I: Giant cervical uterine leiomyoma associated with bilateral ureterohydronephrosis and retroperitoneal perinephric urinoma at the left kidney: A case report and. Med Int 5: 57, 2025.
APA
Thanasa, A., Thanasa, E., Xydias, E., Ziogas, A., & Thanasas, I. (2025). Giant cervical uterine leiomyoma associated with bilateral ureterohydronephrosis and retroperitoneal perinephric urinoma at the left kidney: A case report and. Medicine International, 5, 57. https://doi.org/10.3892/mi.2025.256
MLA
Thanasa, A., Thanasa, E., Xydias, E., Ziogas, A., Thanasas, I."Giant cervical uterine leiomyoma associated with bilateral ureterohydronephrosis and retroperitoneal perinephric urinoma at the left kidney: A case report and". Medicine International 5.5 (2025): 57.
Chicago
Thanasa, A., Thanasa, E., Xydias, E., Ziogas, A., Thanasas, I."Giant cervical uterine leiomyoma associated with bilateral ureterohydronephrosis and retroperitoneal perinephric urinoma at the left kidney: A case report and". Medicine International 5, no. 5 (2025): 57. https://doi.org/10.3892/mi.2025.256
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