(64) Leiomyomata in Adolescents: A Case Series

Background: Leiomyomata are one of the most common causes of abnormal uterine bleeding in adult women. In adolescents however, structural causes of abnormal uterine bleeding are identified as the cause of abnormal bleeding in fewer than 1% of cases. To our knowledge, there have only been 27 cases of leiomyomata reported in the literature in this age group.

Case: We present two cases of adolescent patients with large leiomyomata.

Our first patient presented at age 14 with heavy menstrual bleeding (HMB) and dysmenorrhea. She was also experiencing frequent urination and a sensation of incomplete bladder emptying. She was found to have a 8 cm intramural fundal fibroid and trialed on contraceptive patch, followed by Levonorgestrel (LNG) intrauterine device (IUD) with continued HMB and interval increase of fibroid size to 10.6cm. She underwent open myomectomy at age 16. Pathology revealed benign leiomyoma.

Our second patient presented at 15 years old, with PMH of Von Hippel Lindau (VHL). Her chief complaint at this time was frequent menses, which had recently normalized to monthly before her initial consult with gynecology. She also required contraception and had a known small fibroid (1.4cm at presentation), incidentally found on imaging to monitor for solid tumors due to her history of VHL. Had LNG-IUD placed for contraception. Fibroid monitored with serial pelvic imaging, with interval increase to 10.0 cm over 2.5 years. She had a consult with gynecology oncology and decision was made to proceed with open myomectomy at age 18. Pathology revealed benign leiomyoma.

Comments: While leiomyomata are a rare cause of AUB or dysmenorrhea in adolescents, this case series reviews two patients who had large myomas as pathology. Both had interval growth during follow-up. We continue to believe that in the majority of cases of AUB in adolescents, imaging is not required to establish the diagnosis. However, if a patient has failed multiple lines of medical therapy, it is reasonable to obtain imaging to ensure there is no underlying structural etiology. It is also important to consider co-morbidities such as VHL, as these increase the risk of growing solid tumors such as leiomyomata. Though a rare finding in adolescents, it is reassuring that both cases revealed benign pathology.