Please wait a minute...
Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (1): 135-138    DOI: 10.31083/j.ceog.2020.01.5001
Case Report Previous articles | Next articles
Pregnancy outcomes of a giant primary ovarian leiomyoma in the first trimester
S.Y. Jung1, H.Y. Cho1, S.H. Lee1, S. Lim1, K.B. Lee1, *()
1Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, South Korea
Download:  PDF(53784KB)  ( 131 ) Full text   ( 9 )
Export:  BibTeX | EndNote (RIS)      

Primary ovarian leiomyoma is a rare type of benign neoplasm. Ovarian leiomyoma cases until a recent date usually showed favorable pregnancy outcomes. Contrary to others, the present authors report a case of a nine-week miscarriage with a giant primary ovarian leiomyoma. This neoplasm originated from the ovary with estrogen secreted by the endocrine organs. Hormone secretion is increased during pregnancy, particularly in the first trimester; it is supposed that it stimulated growth and progression of the mass. A close examination in adnexa is necessary at prenatal check.

Key words:  First trimester      Leiomyoma      Miscarriage      Ovarian neoplasms      Pregnancy     
Published:  15 February 2020     
*Corresponding Author(s):  K.B. Lee     E-mail:

Cite this article: 

S.Y. Jung, H.Y. Cho, S.H. Lee, S. Lim, K.B. Lee. Pregnancy outcomes of a giant primary ovarian leiomyoma in the first trimester. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(1): 135-138.

URL:     OR

Figure 1.  — CT image and gross feature of primary ovarian leiomyoma. A) Transverse imaging: the uterus is deviated to the right; a large well-margined mass has a uniformly solid consistency in the pelvic cavity surrounded by the left salpinx. B) Sagittal imaging: there are no suspicious malignancy findings, such as ascites, metastasis, or enlarged lymph nodes. C) The uterus is displaced toward the right and forward. There are no remarkable findings in the right ovary. It has a round shape and well-circumscribed margin within the left ovary capsule without grossly normal ovarian tissues and is distinct from the uterus without coexistent leiomyoma. D) Left oophorectomy specimen: 17×12.5-cm-sized white solid mass.

Table 1  — Case characteristics of ovarian leiomyoma during pregnancy.
Author Maternal
GA1 at
GA at
Size of mass (cm)
ratio of mass2
Olshausen (1907) [9] 38 - 12 Man’s head size Abrupt growing3 Term birth
Moore and Forks (1945) [8] 34 - 12 16×13 Abrupt growing Term birth
Daniel et al (1997) [4] 31 Term Term Right: 8×5,
Left: 10×7
Incidental diagnosis4 Term birth
Kohno et al. (1999) [7] 30 16 20 23×23×20 Abrupt growing Term birth
Hsiao et al. (2007) [5] 42 Before conception Term 4.5×4.4×32 28.6% Term birth
Zhao et al. (2014) [10] 28 Before conception 14 18×16×10 650% Term birth
Kim (2016) [6] 35 Before conception 10 9.3×7.8 28.6% Term birth
Abdessayed et al. (2017) [3] 32 - 18 6.0×5.5 Incidental diagnosis Miscarriage
after operation
Current case 34 - 9 17×12.5 Abrupt growing Miscarriage
at GA 9 weeks
Figure 2.  — Microscopic finding of primary ovarian leiomyoma A) The tumor is well circumscribed. The ovarian stroma is visible on the right lower portion (Hematoxylin & Eosin staining, ×100). B) The tumor consists of spindle cells arranged in inter- secting fascicles (Hematoxylin & Eosin staining, ×200). C) The tumor cells are diffusely positive for smooth muscle actin (immunohistochemical staining, ×200).

[1] Van Winter J.T., Stanhope C.R.: “Giant ovarian leiomyoma associated with ascites and polymyositis”. Obstet.Gynecol., 1992, 80, 560.
[2] Doss B.J., Wanek S.M., Jacques S.M., Qureshi F., Ramirez N.C., Lawrence W.D.: “Ovarian leiomyomas: clinicopathologic features in fifteen cases”. Int. J. Gynecol. Pathol., 1999, 18, 63.
[3] Abdessayed N., bel haj Salah M., Jouini R., Koubaa W., ben Brahim E., Debbiche A.C.: “Primary Ovarian Leiomyoma in Pregnant Woman: An Uncommon Tumor with an Unusual Presentation”. World J. Pathol., 2017, 6, 13.
[4] Daniel Y., Lessing J.B., Bar-Am A., Kupferminc M.J., Jossiphov J., Peyser M.R.: “Treatment of bilateral multiple primary ovarian leiomyomas during pregnancy by way of conservative surgery: a case report”. Eur. J. Obstet. Gynecol. Reprod. Biol., 1997, 74, 125.
[5] Hsiao C-H, Wang H-C., Chang S-L.: “Ovarian leiomyoma in a pregnant woman”. Taiwan J. Obstet. Gynecol., 2007, 46, 311.
[6] Kim M.: “Laparoscopic management of a twisted ovarian leiomyoma in a woman with 10 weeks’ gestation: Case report and literature review”. Medicine, 2016, 95, e5319.
[7] Kohno A., Yoshikawa W., Yunoki M., Yanagida T., Fukunaga S.. “MR findings in degenerated ovarian leiomyoma”. Br. J. Radiol., 1999, 72, 1213.
[8] Moore J.H., Forks G.: “Leiomyoma of the ovary complicating pregnancy”. Am. J. Obstet. Gynecol., 1945, 50, 224.
[9] Olahausen R.V.J.: “Myom und Scliwangerscliaft”. 2nd ed. München: Springer, 1907.
[10] Zhao X., Chen L., Zeng W., Jin B., Du W.: “Laparoscopic tumorectomy for a primary ovarian leiomyoma during pregnancy: A case report”. Oncol. Lett., 2014, 8, 2523.
[11] Macri C.I., Vasilev S.A.: “Bilateral giant primary ovarian leiomyomas. A case report”. J. Reprod. Med., 1993, 38, 480.
[12] Fallahzadeh H., Dockerty M.B., Lee R.A..: “Leiomyoma of the ovary: report of five cases and review of the literature”. Am J Obstet Gynecol. 1972, 113, 394.
[13] Patne S.C., Kumar M., Raghuvanshi S., Agrawal N.R.: “Unilateral primary ovarian leiomyoma with degeneration masquerading as ovarian malignancy”. World J. Surg. Res., 2013, 2, 50.
[14] Tamada T., Sone T., Tanimoto D., Higashi H., Miyoshi H., Egashira N., et al.: “MRI appearance of primary giant ovarian leiomyoma in a hysterectomised woman”. Br. J. Radiol., 2006, 79, e126.
[15] Fasih N., Prasad Shanbhogue A.K., Macdonald D.B., Fraser-Hill M.A., Papadatos D., Kielar A.Z., et al.: “Leiomyomas beyond the Uterus: Unusual Locations, Rare Manifestations 1”. Radiographics, 2008, 28, 1931.
[16] Laughlin S.K., Baird D.D., Savitz D.A., Herring A.H Hartmann K.E.: “Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound screening study”. Obstet. Gynecol., 2009, 113, 630.
[17] Ciavattini A., Carpini G.D., Clemente N., Moriconi L., Gentili C., Di Giuseppe J.: “Growth trend of small uterine fibroids and human chorionic gonadotropin serum levels in early pregnancy: an observational study”. Fertil. Steril., 2016, 105, 1255.
[18] Rosati P., Exacoustos C., Mancuso S.: “Longitudinal evaluation of uterine myoma growth during pregnancy. A sonographic study”. J. Ultrasound Med., 1992, 11, 511.
[19] Segars J.H., Parrott E.C., Nagel J.D., Guo X.C., Gao X., Birnbaum L.S., et al.: “Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations”. Hum. Reprod. Update., 2014, 20, 309.
[20] Wallach E.E., Vu K.K.: “Myomata uteri and infertility”. Obstet. Gynecol. Clin. North Am., 1995, 22, 791.
[1] Ali S. Alqahtani. Seroprevalence of Dengue virus among pregnant mothers and their-newborn infants in the southwest of Saudi Arabia[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 741-743.
[2] M. Elmahdy, I. Elfourtia, H. Maghraby. Office hysteroscopy in cases of recurrent implantation failure; Do or not to do[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 723-728.
[3] L.L. Xu, J.Q. Li, Y.Q. Pu, C. Zhou, S.W. Feng, Q. Luo. Effect of prenatal depression during late pregnancy on maternal and neonatal outcomes[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 681-686.
[4] Y.X. Wang, M. Zhong, H. Yi, H.F. He. Detection of group B streptococcus colonization in cervical and lower vaginal secretions of pregnant women[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 669-674.
[5] I.F. Urunsak, U.K. Gulec, E. Eser, M. Sucu, C. Akcabay, S. Buyukkurt. The role of dinoprostone for labor induction in postterm and high-risk term pregnancies[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 664-668.
[6] N. Al-Husban, A. Hababeh, M. Al-Kasasbeh, R. Odeh, M. Shaheen, D. Moughrabi, D. Zabalawi. Thyroid stimulating hormone (TSH) level variations in early pregnancy and feto-maternal outcome; retrospective study[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 675-680.
[7] S. Han, S. Choi, S. Nah, Y.H. Lee. Preterm labor in mild carbon monoxide poisoning: a case report[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 805-806.
[8] H.S.O. Abduljabbar, H. Abduljabar. A systematic review and meta-analysis of the reported symptoms of Covid 19 in pregnancy[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 632-637.
[9] M. Varras, C. Loukas, N. Nikiteas, V.K. Varra, F.N. Varra, E. Georgiou. Comparison of laparoscopic surgical skills acquired on a virtual reality simulator and a box trainer: an analysis for obstetrics-gynecology residents[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 755-763.
[10] H. Yolli, M.E. Demir, R. Yildizhan. Neutrophil gelatinase associated lipocalin-2 (Ngal) levels in preeclampsia[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 519-523.
[11] K. Chikazawa, K. Imai, T. Kuwata, K. Takagi. Prophylactic laparoscopic adnexal surgery with low-pressure CO2 insufflation for ovarian cysts during the late first trimester or second trimester of pregnancy[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 537-540.
[12] J. A. Villarreal-Rodriguez, L. G. Mancillas Adame, J. Maldonado-Sanchez, A. Guzmán-López, O. R. Treviño-Montemayor, J. G. Gonzalez-Gonzalez, D. Saldívar-Rodríguez. A randomized controlled trial comparing acarbose vs. insulin therapy for gestational diabetes in individuals with inadequate glycemic control by diet alone[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 552-555.
[13] J. Ogawa, S. Suzuki. Risk factors of self-interruption of medications for mental disorders in pregnancy[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 576-578.
[14] A. Daniilidis, G. Dryllis, G. Chorozoglou, M. Politou, R. Dampali, K. Dinas. Substitution of hemoglobin levels in pregnant women with iron supplement: A prospective randomized clinical study[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 579-583.
[15] M. Ohta, N. Keira, S. Yoshida, R. Yasuda, Y. Tarumi, H. Tsuchiya, M. Kikai, T. Nomura, T. Tatsumi. The possible involvement of interleukin-6 in congestive heart failure in a postmenopausal woman with uterine fibromatosis[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 590-595.
No Suggested Reading articles found!