Frontiers in medicine · 2026
Submucosal uterine leiomyoma with complete cystic degeneration mimicking an empty gestational sac: a case report and literature review.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Lin Shunlin, An Di, Xu Zihua
Аннотация
BACKGROUND: Uterine leiomyomas represent the most frequent benign pelvic tumors in women. Although various degenerative changes can occur, the complete cystic transformation of a submucosal leiomyoma-resulting in a large, fluid-filled intracavitary mass-is an exceptional clinical entity. Such presentations often pose diagnostic dilemmas by mimicking other conditions, notably an empty gestational sac.
CASE PRESENTATION: A 42-year-old parous woman (G3P2) presented with irregular vaginal bleeding lasting for 2 months, accompanied by recent-onset lower abdominal pain. Initial transvaginal ultrasonography demonstrated a large (65 mm × 45 mm) unilocular cystic lesion within the uterine cavity, raising the suspicion of an anembryonic pregnancy. Serial serum β-hCG testing yielded negative results. Subsequent hysteroscopy revealed a giant, smooth-walled cystic tumor originating from the posterior wall, which was entirely excised via electrosurgical resection. Preliminary histological evaluation indicated a mesenchymal neoplasm with focal proliferative features. A comprehensive immunohistochemical panel-showing positivity for SMA, Desmin, h-Caldesmon, CD10, and FH; negative 2SC; wild-type p53; a Ki-67 index near 5%; and scarce PHH3-positive cells-ultimately established the diagnosis of a completely degenerated cystic submucosal leiomyoma with focal proliferative activity. Follow-up imaging at 3 months confirmed the absence of recurrence.
CONCLUSION: This case underscores that a completely cystic submucosal leiomyoma warrants consideration in the differential diagnosis of intracavitary cystic lesions, even when imaging findings are suggestive of an empty gestational sac. A negative serum β-hCG is a pivotal diagnostic clue. Hysteroscopy is invaluable for both direct visualization and therapeutic resection, while immunohistochemistry is essential for definitive diagnosis-particularly when initial histopathology is inconclusive.
CASE PRESENTATION: A 42-year-old parous woman (G3P2) presented with irregular vaginal bleeding lasting for 2 months, accompanied by recent-onset lower abdominal pain. Initial transvaginal ultrasonography demonstrated a large (65 mm × 45 mm) unilocular cystic lesion within the uterine cavity, raising the suspicion of an anembryonic pregnancy. Serial serum β-hCG testing yielded negative results. Subsequent hysteroscopy revealed a giant, smooth-walled cystic tumor originating from the posterior wall, which was entirely excised via electrosurgical resection. Preliminary histological evaluation indicated a mesenchymal neoplasm with focal proliferative features. A comprehensive immunohistochemical panel-showing positivity for SMA, Desmin, h-Caldesmon, CD10, and FH; negative 2SC; wild-type p53; a Ki-67 index near 5%; and scarce PHH3-positive cells-ultimately established the diagnosis of a completely degenerated cystic submucosal leiomyoma with focal proliferative activity. Follow-up imaging at 3 months confirmed the absence of recurrence.
CONCLUSION: This case underscores that a completely cystic submucosal leiomyoma warrants consideration in the differential diagnosis of intracavitary cystic lesions, even when imaging findings are suggestive of an empty gestational sac. A negative serum β-hCG is a pivotal diagnostic clue. Hysteroscopy is invaluable for both direct visualization and therapeutic resection, while immunohistochemistry is essential for definitive diagnosis-particularly when initial histopathology is inconclusive.