Pelvic Malignant Tumor with Liver Metastasis is Actually Conventional Leiomyoma with Abdominal Metastasis

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INTRODUCTION: For this case, when the preoperative diagnosis indicated malignant tumor with metastasis, intraoperative frozen section examination was performed to adjust the surgical plan accordingly. This approach helped avoid overtreatment, minimizing the patient’s pain and surgical trauma. This case holds educational significance.

CASE PRESENTATION: A 45-year-old female patient underwent open myomectomy 12 years ago for uterine fibroids and laparoscopic subtotal hysterectomy 10 years ago for the same condition. During this check-up, her CA125 was found to be elevated. Further examinations, including ultrasound, enhanced CT, and enhanced MRI, all suggested a pelvic malignant tumor with liver metastasis. The patient underwent tumor resection, and both intraoperative frozen section and routine histopathologic examination confirmed that the pelvic and subphrenic tumors (which had been considered as liver metastases preoperatively) were both conventional leiomyomas.

CONCLUSIONS: This case highlights that leiomyomas, when metastatic, are easily misdiagnosed as malignant tumors with metastasis, presenting a significant challenge for preoperative diagnosis. Clinicians should maintain a high level of suspicion in such cases to avoid overtreatment. In this case, the intraoperative frozen section played a crucial role in preventing unnecessary pelvic lymph node dissection.