Giant uterine leiomyoma with concurrent endometriosis managed by uterine artery embolisation followed by supravaginal hysterectomy: a case report

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.

uterine leiomyoma; giant fibroid; uterine artery embolisation; hysterectomy; endometriosis; case report

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