{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:21:26Z","timestamp":1793125286899,"version":"4.5.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Uterine leiomyomas represent the most frequent benign pelvic tumors in women. Although various degenerative changes can occur, the complete cystic transformation of a submucosal leiomyoma\u2014resulting in a large, fluid-filled intracavitary mass\u2014is an exceptional clinical entity. Such presentations often pose diagnostic dilemmas by mimicking other conditions, notably an empty gestational sac.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 42-year-old parous woman (G3P2) presented with irregular vaginal bleeding lasting for 2 months, accompanied by recent-onset lower abdominal pain. Initial transvaginal ultrasonography demonstrated a large (65 mm \u00d7 45 mm) unilocular cystic lesion within the uterine cavity, raising the suspicion of an anembryonic pregnancy. Serial serum \u03b2-hCG testing yielded negative results. Subsequent hysteroscopy revealed a giant, smooth-walled cystic tumor originating from the posterior wall, which was entirely excised via electrosurgical resection. Preliminary histological evaluation indicated a mesenchymal neoplasm with focal proliferative features. A comprehensive immunohistochemical panel\u2014showing positivity for SMA, Desmin, h-Caldesmon, CD10, and FH; negative 2SC; wild-type p53; a Ki-67 index near 5%; and scarce PHH3-positive cells\u2014ultimately established the diagnosis of a completely degenerated cystic submucosal leiomyoma with focal proliferative activity. Follow-up imaging at 3 months confirmed the absence of recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case underscores that a completely cystic submucosal leiomyoma warrants consideration in the differential diagnosis of intracavitary cystic lesions, even when imaging findings are suggestive of an empty gestational sac. A negative serum \u03b2-hCG is a pivotal diagnostic clue. Hysteroscopy is invaluable for both direct visualization and therapeutic resection, while immunohistochemistry is essential for definitive diagnosis\u2014particularly when initial histopathology is inconclusive.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1858581","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:45:56Z","timestamp":1782452756000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Submucosal uterine leiomyoma with complete cystic degeneration mimicking an empty gestational sac: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Shunlin","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Gynecology, Huidong County People\u2019s Hospital, Huizhou","place":["Guangdong, 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