Question: Hi there,

Good Morning,

I am Dr. XXXXXXX Nadeem, working in Insurance Company. I have one Gynecology case. I Need to have your expert opinion on this case.

This is 44 years old female member presented in the hospital with the complaints of fullness and abdominal pain. She is also complaining of abdominal mass. She is complaining of these symptoms for the last 6 months. As per the treating doctor, she didn’t consult any doctor in this last 6 months.

Clinical examination

Physical examination of the abdomen showed palpable mass reaching up to the umbilicus.

Past Medical/Surgical history/Obstetrical history:

• She is Para 1+0.
• LMP: 28/04/2015
• No previous surgical procedure done.

Past Family history:

Nothing significant.

Investigations:

Histopathology report

• Endometrium biopsy:
o Disordered proliferative endometrium.
o Endocervical glands with squamous metaplasia.
• Endometrial polyp biopsy: Disordered proliferative endometrium. No evidence of polyp is seen in the specimen submitted.

Pelvis ultrasound:

• Multiple intramural uterine fibroids do not show any significant interval changes in size or texture.
• Normal endometrial lining measures 0.68 cm, the uterine cavity is empty.
• Both ovaries are normal in size and texture, no ovarian cysts seen.
• The echogenic focus within the left cornous is still visualized of same size & texture denotes benign nature.
• No free pelvic fluid or adnexal masses.
• Impression: Unchanged intramural uterine fibroids and no ovarian cysts.

Cytology gynecology report of Cervical smear:

• Endocervical cells present.
• Reactive cellular changes associated with marked inflammation.
• Fungal organisms (budding yeast and spores) morphologically consistent with Candida species.
• Impression: Negative for Intraepithelial lesion or malignancy.

Pelvis ultrasound:

• The uterus is anteverted, size is enlarged and bulky.
• Multiple circumscribed sharply marginated, heterogeneous capsulated hypoechoic nodules of varying sizes from lcm to <5 cm are located in intramural plane.
• No area of calcification or necrosis found within the masses.
• The endometrial echotexture and thickness (2mm) are normal.
• There is no evidence of free fluid in the POD.
• Ovaries: right ovary has normal functional cyst of <3cm. Left ovary is obscured.
• There is no evidence of any adnexal mass lesion.
• Impression: Finding are suggestive of multicentric intramural uterine Leiomyoma of sizes 1 cm to <5cm.

Lab test results (16/04/2015)

• WBC count: 7.6
• RBC count: 4.14
• HGB: 12.2 g/dl
• HCT: 35.9% (slightly decreased)
• MCV: 86.8 fL
• MCH: 29.4 pg
• MCHC: 33.9 g/dL
• RDW: 12.0%
• Platelet count: 332
• MPV: 7.2 fL (decreased)
• Creatinine: 0.5

Diagnosis:
• Multiple uterine myomas.

Treating doctor is requesting for total abdominal hysterectomy. however our concern is why hysterectomy is opted in this case, why not myomectomy.

please give us your expert opinion on this case about the hysterectomy Vs Myomectomy.