Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2019; 7(19): 3027-3032
Published online Oct 6, 2019. doi: 10.12998/wjcc.v7.i19.3027
Laparoscopic hysterectomy as optimal approach for 5400 grams uterus with associated polycythemia: A case report
Antonio Macciò, Giacomo Chiappe, Fabrizio Lavra, Elisabetta Sanna, Romualdo Nieddu, Clelia Madeddu
Antonio Macciò, Giacomo Chiappe, Fabrizio Lavra, Elisabetta Sanna, Romualdo Nieddu, Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Cagliari 09100, Italy
Clelia Madeddu, Department of Medical Sciences and Public Health, Medical Oncology Unit, University of Cagliari, Cagliari 09042, Italy
Author contributions: Macciò A was responsible for the case management, the approach design, the manuscript writing and the revision of the manuscript for important intellectual content; Macciò A, Chiappe G, Lavra F, Sanna E, Nieddu R were the patient’s surgeons, were involved in the direct patient care, reviewed the literature and contributed to manuscript drafting and reviewing; Macciò A, Sanna E, Madeddu C analyzed and interpreted the imaging findings; Madeddu C performed the laboratory analysis, reviewed the literature and drafted and revised the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2013), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Antonio Macciò, MD, Chief Doctor, Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Via Jenner, Cagliari 09100, Italy.
Telephone: +39-70-6754228
Received: May 7, 2019
Peer-review started: May 10, 2019
First decision: August 1, 2019
Revised: August 3, 2019
Accepted: August 20, 2019
Article in press: August 20, 2019
Published online: October 6, 2019

Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare. Polycythemia is significantly associated with risk of venous thromboembolism (VTE), which is further increased in case of a large pelvic mass and obesity. Here we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated polycythemia.


A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous uterus. She suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several months. Laboratory analyses including hemoglobin (Hb) 19.2 g/dL and hematocrit (Hct) 59.7% were indicative of polycythemia. Arterial blood gas analysis showed arterial oxygen pressure (pO2) of 81.5 mmHg. Abdominal computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm × 17 cm × 25 cm. To reduce the thromboembolic risk, the patient underwent low molecular weight heparin, phlebotomy twice before surgery, and we opted for a laparoscopic hysterectomy. The uterus weighed 5400 g and the histology confirmed a diagnosis of leiomyoma. We did not find increased erythropoietin levels in the supernatant of the myomatous uterine tissue. There were no complications. On postoperative day 1, the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%, respectively. Arterial blood gas analysis after surgery showed a pO2 of 144.7 mmHg. These results suggested the diagnosis of myomatous erythrocytosis syndrome. The patient was discharged on the second postoperative day in very good condition with no symptoms.


We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus, polycythemia and obesity. Multiple VTE risk factors warranted a laparoscopic approach.

Keywords: Hysterectomy, Laparoscopy, Myoma, Myomatous erythrocytosis syndrome, Polycythemia, huge uterus, Total laparoscopic hysterectomy, Case report

Core tip: Uterine myoma are rarely associated with polycythemia. Here we report the challenging case of an obese patient with a giant fibromatous uterus and associated polycythemia; these factors increased significantly the risk of venous thromboembolism. To reduce such risk, we opted for a laparoscopic hysterectomy, which was preceded by phlebotomy. Laparoscopy was successfully completed without complications. The uterus weighed 5400 g. After surgery the patient’s hematological profile normalized. The final diagnosis was myomatous erythrocytosis syndrome (MES). To our knowledge, this is the first case of laparoscopic hysterectomy in an obese patient with a very large uterus and polycythemia due to MES.