Growth Potential and Management of Symptomatic Uterine Leiomyomas: Analysis of Two Clinical Cases

Abstract

Uterine leiomyomas are the most common benign pelvic neoplasms in women of reproductive age. Although benign, specific subgroups exhibit aggressive growth dynamics leading to severe clinical complications, including acute anemia, pelvic pressure, and organ displacement [1]. This article presents a comparative analysis of two contrasting clinical cases of rapidly growing, highly symptomatic leiomyomas to highlight the key clinical drivers behind surgical decision-making and patient-tailored management. Methods: We reviewed two anonymized medical records evaluating clinical presentation, preoperative optimization (specifically intravenous iron therapy), magnetic resonance imaging (MRI) mapping, surgical strategy (hysterectomy vs. myomectomy; ovarian preservation vs. bilateral salpingo-oophorectomy), and long-term postoperative outcomes. Results: Case 1 presents a 45-year-old nulliparous patient with severe iron deficiency anemia (Hb 7.4 g/dL and a 25 cm confluent transmural leiomyoma mass. Despite nulliparity, total abdominal hysterectomy with ovarian preservation was performed due to total myometrial destruction, making polymyomectomy technically unfeasible. Case 2 involves a 49-year-old pauciparous patient with a 12 cm isthmic fibroid causing severe compressive urinary symptoms; total abdominal hysterectomy with bilateral salpingo-oophorectomy was selected given her perimenopausal age and involvement of adnexal structures. At 3-month and 6-month follow-ups, both patients achieved complete symptom resolution, with hemoglobin levels normalizing to 13.1 g/dL in Case 1. Conclusion: Management of rapidly growing uterine fibroids requires individualized decision-making balancing tumor anatomy, clinical urgency, patient age, and fertility desires. Preoperative hemoglobin optimization and high-resolution MRI mapping are paramount to minimizing surgical morbidity and guiding optimal surgical approaches.