{"paper_id":"b821be30-263b-44c4-8465-8d2e4ec816d1","body_text":"Giant uterine leiomyoma with concurrent endometriosis managed by uterine artery embolisation followed by supravaginal hysterectomy: a case report\nDOI:\nhttps://doi.org/10.66636/gmj.v1.i3.a187Keywords:\nuterine leiomyoma, giant fibroid, uterine artery embolisation, hysterectomy, endometriosis, case reportAbstract\nAbstract: Uterine leiomyomas are the most common benign tumours of the female reproductive tract, but giant leiomyomas exceeding 20 cm in diameter or 11.3 kg in weight are rare and pose significant management challenges. We report a 42-year-old Caucasian woman with a six-year history of a progressively enlarging uterine fibroid, reaching 30 cm cranio-caudally on MRI. In keeping with her wish to preserve the uterus, uterine artery embolisation (UAE) was performed first; however, post-procedure haemoglobin fell from 119 to 88 g/L, reflecting the fibroid's necrotic, hypervascular burden. Supravaginal hysterectomy was subsequently performed without complication. Histopathology confirmed a benign leiomyoma (dominant nodule 21 × 18 × 15 cm) with concurrent grade I endometriosis. This case illustrates the diagnostic and therapeutic complexity of giant uterine leiomyomas, highlights the limitations of UAE as definitive therapy in extreme fibroid sizes, and underscores the importance of a staged, multidisciplinary management approach when uterus-preserving treatment alone proves insufficient.\nKeywords: uterine leiomyoma; giant fibroid; uterine artery embolisation; hysterectomy; endometriosis; case report\nReferences\n1. Munro MG. The epidemiology and pathogenesis of uterine fibroids. Int J Gynaecol Obstet. 2025. https://doi.org/10.1002/ijgo.70527\n2. Machado-Lopez A, Simon C, Mas A. Molecular and cellular insights into the development of uterine fibroids. Int J Mol Sci. 2021;22(16):8483. https://doi.org/10.3390/ijms22168483\n3. Giannios K, Anestiadou E, Liampou E, Spilioti LK, Bakaloudi DR, Papadopoulos V. Case report: giant hydropic leiomyoma of the uterus presenting as an aggressive abdominopelvic tumor. Front Oncol. 2025;15:1529793. https://doi.org/10.3389/fonc.2025.1529793\n4. Llerena Freire LF, Llerena Ojeda CA, Llerena Morales GA, Vela Arias GD, Arteaga Teran JL, Valle Acurio CY, et al. Giant uterine leiomyoma successfully managed by surgical excision: a case report. J Surg Case Rep. 2026;2026(4):rjag314. https://doi.org/10.1093/jscr/rjag314\n5. 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. Med Int (Lond). 2025. https://doi.org/10.3892/mi.2025.256\n6. Rout M, Dave A, Bakshi SS. Therapeutic management of giant uterine fibroid: a case report. Cureus. 2023;15(11):e48169. https://doi.org/10.7759/cureus.48169\n7. Lin KYH, Yang CY, Lam A, Chang CYY, Lin WC. Uterine leiomyoma is associated with the risk of developing endometriosis: a nationwide cohort study involving 156,195 women. PLoS One. 2021;16(8):e0256772. https://doi.org/10.1371/journal.pone.0256772\n8. Ubaldi N, Tipaldi MA, Giannini A, Golia D'Auge T, Caserta D, Lagana AS, et al. Uterine fibroid embolization: an analysis of clinical outcomes and impact on patients' quality of life. Med (Kaunas). 2025. https://doi.org/10.1515/med-2025-1235\n9. Goodwin SC, Bonilla SC, Sacks D, Reed RA, Spies JB, Landow WJ, et al. Reporting standards for uterine artery embolization for the treatment of uterine leiomyomata. J Vasc Interv Radiol. 2001;12(9):1011–1020. https://doi.org/10.1097/01.RVI.0000094620.61428.9c\n10. Loughborough WW, Rockall AG, Gagliardi TT, Satchwell L, Greenlay E, Osborne P, et al. Comparison of MRI imaging features to differentiate degenerating fibroids from uterine leiomyosarcomas. Rare Tumors. 2025;17:20363613251327080. https://doi.org/10.1177/20363613251327080\nDownloads\nPublished\nHow to Cite\nIssue\nSection\nLicense\nCopyright (c) 2026 Nishat Altaf Deraiya, Mosammat Dareen Sanzana, Mosammat Allin Sanzana, Natalia Ramishvili\nThis work is licensed under a Creative Commons Attribution 4.0 International License.\nThis article is published open access under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence.\nYou are free to: share and adapt the work for any purpose, even commercially.\nConditions: provide appropriate credit to the authors and the Georgian Medical Journal (GMJ), link to the licence, and indicate if changes were made. Do not apply legal terms or technological measures that legally restrict others from doing anything the licence permits.\nLicence: creativecommons.org/licenses/by/4.0 · Legal code: creativecommons.org/licenses/by/4.0/legalcode\nThird-party material. 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