Premyomectomy Uterine Fibroid Embolization for Massive Uterine Enlargement

CASE HISTORY A 35-year-old woman (gravida 3, para 0030) presented with complaints of abdominal discomfort and distension, dysmenorrhea, and menorrhagia. Physical examination revealed a pelvic mass comparable to 38 weeks’ gestation, thought to consist of uterine fibroids. The tumors displaced the anatomic position of the cervix, making it impossible to obtain an endometrial biopsy sample. Computed tomography confirmed the mass to be a massively enlarged uterus with multiple fibroids (Figure 1). The patient strongly desired future fertility and uterine preservation, so that hysterectomy was not an option. Uterine fibroid embolization (UFE) was discussed as a primary treatment, but was not thought to be the best solution. Even with a 40% to 50% reduction in fibroid volume, the patient’s bulk symptoms would not be effectively treated. Additionally, the uterine cavity would most likely remain distorted, potentially causing subfertility. Abdominal myomectomy was recommended as the best treatment option for both relieving the patient’s symptoms and maximizing future fertility. Uterine Jay Goldberg, MD, MSCP, is director, Division of General Obstetrics and Gynecology; and director, Jefferson Fibroid Center. Shannon Cothran, MD, is PGY3 resident, Obstetrics and Gynecology. Both are at Jefferson Medical College, Philadelphia, Pa. Joseph Bonn, MD, is director, Interventional Radiology, The Lankenau Hospital, Wynnwood, Pa. FIGURE 1.