Intramural uterine leiomyomas in early anamnesis

Clinical case

Authors

DOI:

https://doi.org/10.18370/2309-4117.2025.81.60-64

Keywords:

uterine leiomyoma, gonadotropin-releasing hormone agonists, conservative myomectomy

Abstract

Background. Uterine leiomyomas are benign smooth muscle tumors with significant global economic and healthcare impact. While typical in the fourth decade of a woman’s life, cases diagnosed in patients around 20 years old suggest unique biological mechanisms, including genetic predisposition (MED12 and HMGA2 gene mutations) and epigenetic reprogramming. Clinical case. A retrospective analysis of two clinical cases of intramural uterine leiomyomas, incidentally diagnosed in women aged 20 years, with tracking of their clinical evolution over 20 years is presented.
Both patients remained asymptomatic for more than two decades, successfully realizing reproductive function. However, after the age of 40, both women experienced rapid tumor growth (up to 7–10 cm in diameter) and severe abnormal uterine bleeding.
Treatment included preoperative therapy with gonadotropin-releasing hormone agonist (Zoladex) followed by successful conservative myomectomy. Menstruation in both patients resumed within a few months after the completion of postoperative gonadotropin-releasing hormone agonist therapy, and none of them was found to have disease recurrence during 15–16 months of follow-up.
Histopathological examination revealed different variants of uterine leiomyomas: multiple proliferating leiomyomas in clinical case 1 (indicating a probable pathway associated with a MED12 gene mutation) and solitary cell leiomyoma in clinical case 2 (indicating a probable pathway associated with an HMGA2 gene mutation).
Conclusions. Early-onset uterine leiomyoma exhibits a long indolent phase followed by aggressive symptomatic transformation in the perimenopausal period. A combined approach of gonadotropin-releasing hormone agonists and myomectomy is an effective organ-preserving strategy. Long-term follow-up and personalized molecular analysis are crucial for managing these patients.

Author Biographies

N.P. Tsip, National Cancer Institute, Kyiv

MD, oncogynaecologist, Scientific and Clinical Department of Neoplasms of the Female Reproductive System

O.О. Bakai, National Cancer Institute, Kyiv

PhD, radiologist

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Published

2025-12-30

How to Cite

Tsip, N., & Bakai, O. (2025). Intramural uterine leiomyomas in early anamnesis: Clinical case. REPRODUCTIVE ENDOCRINOLOGY, (81), 60–64. https://doi.org/10.18370/2309-4117.2025.81.60-64

Issue

No. 81 (2025)

Section

Tumors and pretumoral pathology

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