{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:08:22Z","timestamp":1787656102430,"version":"build-2736575974"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"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. Oncol."],"abstract":"<jats:p>Hydropic leiomyoma (HLM) is a rare subtype of uterine leiomyoma characterized by significant interstitial fluid accumulation, often mimicking malignant tumors due to its imaging features. Although most uterine leiomyomas are benign and commonly occur in women of reproductive age, HLM can grow to an unusually large size, leading to diagnostic challenges. In this case report, we present a case of a 59-year-old postmenopausal woman with a giant HLM exhibiting extensive cystic hydropic degeneration resembling an aggressive abdominopelvic tumor. The tumor measured 35 \u00d7 27 \u00d7 17 cm and caused a significant mass effect on surrounding organs. Surgical management involved a total abdominal hysterectomy with right salpingo-oophorectomy via midline laparotomy. Intraoperative findings included displacement of the small bowel, transverse colon, and greater omentum by the tumor, with adherence of the left adnexa to the external surface of the uterus. A left ureteral transection occurred during tumor dissection and was successfully repaired with ureteral reanastomosis and placement of a pigtail stent. The operation lasted 4 hours 11 minutes, and the patient had an uncomplicated postoperative recovery. Histopathological examination confirmed the diagnosis of HLM with extensive cystic degeneration. Based on available literature, this case appears to represent the largest HLM reported to date, highlighting the importance of accurately distinguishing benign from malignant tumors to guide appropriate clinical management. This case underscores the complexities associated with diagnosing and surgically treating large, degenerating uterine leiomyomas.<\/jats:p>","DOI":"10.3389\/fonc.2025.1529793","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T04:18:05Z","timestamp":1761106685000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Giant hydropic leiomyoma of the uterus presenting as an aggressive abdominopelvic tumor"],"prefix":"10.3389","volume":"15","author":[{"given":"Konstantinos","family":"Giannios","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elissavet","family":"Anestiadou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eftychia","family":"Liampou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia Konstantina","family":"Spilioti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra Rafailia","family":"Bakaloudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Papadopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.5114\/aoms\/171786","article-title":"Global epidemiological characteristics of uterine fibroids","volume":"19","author":"Li","year":"2023","journal-title":"Arch Med Sci"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1093\/molehr\/gat083","article-title":"Clonality of smooth muscle and fibroblast cell populations isolated from human fibroid and myometrial tissues","volume":"20","author":"Holdsworth-Carson","year":"2014","journal-title":"Mol Hum Reprod"},{"key":"B3","unstructured":"Alran\n              L\n            \n            \n              Rychlik Agnieszka\n              CS\n            \n          \n          Leiomyoma-General"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.14.13946","article-title":"Review of leiomyoma variants","volume":"205","author":"Arleo","year":"2015","journal-title":"Am J Roentgenol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2007.12.046","article-title":"Massive cystic degeneration of a pedunculated leiomyoma","volume":"90","author":"Dancz","year":"2008","journal-title":"Fertil Steril"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.12659\/AJCR.929085","article-title":"Giant leiomyoma with massive cystic hydropic degeneration mimicking an aggressive neoplasm: A challenging case with a literature review","volume":"22","author":"Akkour","year":"2021","journal-title":"Am J Case Rep"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-020-02882-z","article-title":"MRI-based pictorial review of the FIGO classification system for uterine fibroids","volume":"46","author":"Gomez","year":"2021","journal-title":"Abdom Radiol (N Y)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1097\/00000478-199201000-00004","article-title":"Diffuse, perinodular, and other patterns of hydropic degeneration within and adjacent to uterine leiomyomas. Problems in differential diagnosis","volume":"16","author":"Clement","year":"1992","journal-title":"Am J Surg Pathol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1055\/a-1545-4279","article-title":"2020 WHO classification of female genital tumors","volume":"81","author":"H\u00f6hn","year":"2021","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2018.09.012","article-title":"Hydropic leiomyoma: A distinct variant of leiomyoma closely related to HMGA2 overexpression","volume":"84","author":"Griffin","year":"2019","journal-title":"Hum Pathol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.radcr.2022.06.008","article-title":"Hydropic leiomyoma: A radiologic pathologic correlation of a rare uterine tumor","volume":"17","author":"Lameira","year":"2022","journal-title":"Radiol Case Rep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1002\/ijgo.13102","article-title":"Epidemiology and management of uterine fibroids","volume":"149","author":"Giuliani","year":"2020","journal-title":"Int J Gynecol Obstet"},{"key":"B13","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.bpobgyn.2015.11.018","article-title":"The epidemiology and genetics of uterine leiomyoma","volume":"34","author":"Styer","year":"2016","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1148\/rg.220161","article-title":"Smooth muscle tumors of the uterus at MRI: focus on leiomyomas and FIGO classification","volume":"43","author":"Tu","year":"2023","journal-title":"Radiographics"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-199406000-00001","article-title":"Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases","volume":"18","author":"Bell","year":"1994","journal-title":"Am J Surg Pathol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1148\/radiographics.19.5.g99se131179","article-title":"Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment","volume":"19","author":"Murase","year":"1999","journal-title":"RadioGraphics"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20210283","article-title":"MRI findings in-between leiomyoma and leiomyosarcoma: A rad-path correlation of degenerated leiomyomas and variants","volume":"94","author":"Bura","year":"2021","journal-title":"Br J Radiol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2013.54.1.215","article-title":"Degeneration of leiomyoma in patients referred for uterine fibroid embolization: incidence, imaging features and clinical characteristics","volume":"54","author":"Han","year":"2013","journal-title":"Yonsei Med J"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1148\/radiographics.19.suppl_1.g99oc04s131","article-title":"Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds","volume":"19","author":"Ueda","year":"1999","journal-title":"Radiogr Rev Publ Radiol Soc North Am Inc"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.2463\/mrms.mp.2018-0074","article-title":"Evaluation of red degeneration of uterine leiomyoma with susceptibility-weighted MR imaging","volume":"18","author":"Takeuchi","year":"2019","journal-title":"Magn Reson Med Sci"},{"key":"B21","doi-asserted-by":"publisher","first-page":"3415","DOI":"10.18203\/2320-1770.ijrcog20223145","article-title":"Myxoid degeneration of leiomyoma-a masquerader","volume":"11","author":"Panda","year":"2022","journal-title":"Int J Reprod Contraception Obstet Gynecol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"26","DOI":"10.4103\/jcis.JCIS_13_17","article-title":"Uterine Lipoleiomyoma: A report of two cases","volume":"7","author":"Nazir","year":"2017","journal-title":"J Clin Imaging Sci"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.4103\/ijri.IJRI_472_17","article-title":"Hydropic degeneration of leiomyoma in nongravid uterus: the \u201cSplit fiber\u201d Sign on magnetic resonance imaging","volume":"28","author":"Patil","year":"2018","journal-title":"Indian J Radiol Imaging"},{"key":"B24","article-title":"Uterine leiomyomas with perinodular hydropic degeneration: A report of two cases","volume":"36","author":"Kim","year":"2002","journal-title":"Korean J Pathol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1767","DOI":"10.18203\/2320-1770.ijrcog20221455","article-title":"Hydropic leiomyoma, a considerable differential diagnosis: A case series","volume":"11","author":"El Ghali","year":"2022","journal-title":"Int J Reprod Contraception Obstet Gynecol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1111\/his.12298","article-title":"Immunohistochemistry of soft tissue tumours - review with emphasis on 10 markers","volume":"64","author":"Miettinen","year":"2014","journal-title":"Histopathology"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2015.139","article-title":"Practical issues in uterine pathology from banal to bewildering: the remarkable spectrum of smooth muscle neoplasia","volume":"29","author":"Oliva","year":"2016","journal-title":"Mod Pathol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1186\/s12905-024-03285-8","article-title":"Pseudo-meigs syndrome caused by a rapidly enlarging hydropic leiomyoma with elevated CA125 levels mimicking ovarian Malignancy: A case report and literature review","volume":"24","author":"Zou","year":"2024","journal-title":"BMC Womens Health"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2018-226454","article-title":"Hydropic leiomyoma presenting as a rare condition of pseudo-meigs syndrome: literature review and a case of a pseudo-meigs syndrome mimicking ovarian carcinoma with elevated CA125","volume":"12","author":"Pauls","year":"2019","journal-title":"BMJ Case Rep"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/50866065","article-title":"Case report: hydropic leiomyoma of the uterus presenting in pregnancy: imaging features","volume":"82","author":"Heffernan","year":"2009","journal-title":"Br J Radiol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.7863\/jum.1994.13.5.416","article-title":"Giant hydropic uterine leiomyoma in pregnancy: unusual sonographic and doppler appearance","volume":"13","author":"Moore","year":"1994","journal-title":"J Ultrasound Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/2012376","article-title":"Retroperitoneal hydropic leiomyoma mimicking an ovarian cyst","volume":"2022","author":"Lai","year":"2022","journal-title":"Case Rep Obstet Gynecol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2024.109788","article-title":"Uterine leiomyoma torsion: A rare cause of acute abdominal pain","volume":"122","author":"Khaoula","year":"2024","journal-title":"Int J Surg Case Rep"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18115895","article-title":"The rare, unexpected condition of a twisted leiomyoma in mayer-rokitansky-k\u00fcster-hauser (MRKH) syndrome: etiopathogenesis, diagnosis and management. Our experience and narrative review of the literature","volume":"18","author":"Romano","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1177\/2050313X251315066","article-title":"Giant degenerative uterine leiomyoma mimicking an ovarian neoplasm: case report","volume":"13","author":"Hoang","year":"2025","journal-title":"SAGE Open Med Case Rep"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/bcr-2015-211929","article-title":"Hydropic leiomyoma of the uterus presenting as a giant abdominal mass","volume":"2015","author":"Horta","year":"2015","journal-title":"BMJ Case Rep"},{"key":"B37","doi-asserted-by":"publisher","first-page":"e35964","DOI":"10.1097\/MD.0000000000035964","article-title":"Uterine torsion with degeneration and infarction of giant leiomyoma in a postmenopausal woman: A case report","volume":"102","author":"Ye","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"B38","doi-asserted-by":"publisher","first-page":"64","DOI":"10.3390\/medicina60010064","article-title":"Exploring surgical strategies for uterine fibroid treatment: A comprehensive review of literature on open and minimally invasive approaches","volume":"60","author":"Cianci","year":"2024"},{"key":"B39","doi-asserted-by":"publisher","first-page":"868","DOI":"10.3390\/medicina60060868","article-title":"Currently available treatment modalities for uterine fibroids","volume":"60","author":"Mici","year":"2024"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1529793\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T04:18:08Z","timestamp":1761106688000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1529793\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,22]]},"references-count":39,"alternative-id":["10.3389\/fonc.2025.1529793"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1529793","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,22]]},"article-number":"1529793"}}