Giant Uterine Leiomyoma With Concomitant Occult Ovarian Carcinoma: A Case Report.

Uterine leiomyomas are common benign tumors, whereas "giant" leiomyomas occupying most of the abdominal cavity are now uncommon and can pose diagnostic and operative challenges. We present the case of a 45-year-old woman with progressive abdominal distension and long-standing menorrhagia. Computed tomography demonstrated a massive uterine fundal mass consistent with a giant subserosal leiomyoma and a separate right adnexal cystic lesion. The patient underwent elective midline laparotomy and total abdominal hysterectomy with bilateral salpingo-oophorectomy. The ovarian cyst was removed intact without capsular rupture, and peritoneal washings were obtained. Estimated blood loss was 80 mL. Postoperative recovery followed an enhanced recovery after surgery (ERAS) pathway, enabling discharge on postoperative day four. Final histopathology confirmed a giant subserosal leiomyoma measuring 44 × 38 × 30 cm and revealed an occult clear cell carcinoma confined to the ovarian cyst (FIGO stage IA), with negative peritoneal cytology. Completion staging surgery and adjuvant-treatment discussion were recommended at a multidisciplinary tumor board; however, the patient declined further extensive surgery and was referred to medical oncology for adjuvant management and close surveillance. This case highlights the complexity of removal in giant uterine tumors, careful handling of adnexal cysts to avoid intraoperative rupture, and the feasibility of ERAS-based recovery.