Massive Uterine Leiomyomatosis Requiring Hysterectomy in a 25-Year-Old Woman: A Case Report.

Uterine leiomyomas are the most common benign tumors in women of reproductive age. Although hysterectomy is the definitive treatment for symptomatic fibroids, uterine-preserving procedures are preferred in young women, particularly when fertility is desired. Hysterectomy in women in their 20s due to extensive leiomyomatosis is uncommon. We report the case of a 25-year-old multiparous woman who presented with progressive abdominal distension, constipation, heavy menstrual bleeding, and dysmenorrhea for one year. Examination revealed a large abdominopelvic mass extending to the xiphisternum. Imaging demonstrated a massive, multinodular uterine mass that replaced the uterus. Following counseling regarding myomectomy and possible hysterectomy, an exploratory laparotomy was performed. Intraoperatively, the uterus was completely replaced by multiple leiomyomata, making myomectomy impossible. Total abdominal hysterectomy with ovarian conservation was undertaken. The specimen measured 22 × 17 × 8 cm and weighed 4.1 kg. Histopathology confirmed multiple benign leiomyomas without atypia or malignant features. Recovery was uneventful. This case highlights that uterine preservation should be pursued whenever safely feasible; however, hysterectomy may represent the safest option when complete replacement of the uterus precludes reconstruction.