Rare case presentation of symplastic leiomyoma in nulliparous female

We present a case of a 26-year-old female, nulligravida, who presented in outpatient department in our hospital with ultrasound suggestive of multiple huge fibroids at posterior wall and right lateral wall. Patient gave a history of myomectomy done in the past 2 years back. Histopathology was suggestive of benign leiomyoma. Ultrasound Doppler and magnetic resonance imaging were suggestive of multiple large size highly vascular fibroids in posterior and lateral wall of uterus of size 11 cm × 10 cm × 5 cm, compressing uterus and bladder with venous congestion. Intraoperatively, uterus was enlarged with multiple fibroids with sarcomatous changes in it. Largest of size 20 cm × 15 cm × 10 cm with increased vascularity with ovaries and bowel adhered to uterus. Total abdominal hysterectomy with B/L pelvic lymph node dissection with omentectomy was done. Histopathology was suggestive of symplastic leiomyoma. Diagnosis was confirmed by immunohistochemistry as symplastic leiomyoma.