Case history
A 34‐year‐old female that referred to a gynecologist in Mashhad, Iran in
December 2022, with the chief complaint of hypogastric pain lasting more
than 1 year which was firstly diagnosed as Pelvic inflammatory disease
(PID). The initial trans-vaginal ultrasound revealed heterogeneous right
adnexal mass with irregular margin measuring 3.1 × 6.3 cm in size and
multi nodular small size mass on the right side of Culdesac.
Abdominopelvic computed tomography (CT) scan in April 2023 illustrated
solid masses in the pancreatic head
(Figure 1A) and small intestine
wall (Figure 1B) also solid cystic complex mass on the right side of
pelvis, measuring 3 × 6 cm in size in the right parametrial space that
extended and attached to right ovary (Figure 2A,B). Tumor marker CA125,
CEA, CA19-9, βhCG and LDH were normal. Abdominopelvic sonography
revealed normal abdominal viscera with a fluid-filled folded and tubular
liquid right adnexal lesion measuring 2.9 × 6.7 cm suggesting long term
lasting pyosalpinx. The abdominal pain had progressively worsened and
she was referred for colonoscopy and endoscopy evaluation that revealed
normal results. The patient was a candidate for diagnostic laparascopy
in December 2023 since persistent abdominal pain, multiple smooth
muscle-like nodules suggesting diffuse peritoneal lyomayomatosis was
seen during operation, biopsies from omental lesions were obtained and
referred to pathology, and the microscopic pathology findings confirmed
myoma.