Uterine leiomyoma in adolescents: A case report and a review of the literature

Introduction

Fibroids are common benign gynecological tumors but a rare finding in adolescents. Although infrequent, some symptomatic cases have been described in literature.

Main symptoms and/or clinical findings

A 16-year-old Caucasian patient came to our attention for abdominal pain and dysmenorrhea appeared two months before. Her gynecological history was characterized by regular menstrual cycles, normal in quantity, with dysmenorrhea. Bimanual pelvic examination revealed an anteverted mobile uterus, no adnexal tenderness or masses. Speculum examination showed a normal cervix. No vaginal bleeding or discharge was observed during the visit.

Main diagnoses

Transabdominal/transvaginal ultrasound demonstrated an anteverted uterus of 71 mm × 44 × 48 mm, with a heterogeneous myometrial structure and a hypoechoic subserosal-intramural mass (FIGO leiomyoma subclassification system: O-4) localized in the posterior uterine wall, measuring 26 mm × 19 mm × 16 mm, slightly vascularized at the Color-Doppler (Color Score 2). Magnetic resonance imaging confirmed the ultrasound diagnosis.

Therapeutic interventions and outcomes

Considering pelvic mass dimension and the patient age, a “wait and see” approach was chosen and the patient was re-evaluated a month and three months after the first ultrasound. The second and the third transvaginal ultrasound exam showed an unchanged picture.

Conclusion

The management of leiomyoma in young patients should be targeted to dimension and symptoms of the mass. When facing myomas of small dimension, paucisymptomatic or asymptomatic, with no signs of malignity, we suggest an expectant management.