title: The diagnostic and therapeutic approach of a primary bilateral leiomyoma of the ovaries: a case report and a literature review.
abstract: BACKGROUND
  A primary fibroid (leiomyoma) arising from both ovaries is rare and can be difficult to diagnose as a result of the low incidence and its indistinctive presentation. A literature review on the diagnostic and therapeutic approach of this rare benign tumour is presented. We describe a case of bilateral primary ovarian fibroid with an unusual presentation to illustrate our recommendations for treatment.
  
  
  METHODS
  A 37-year-old woman was admitted with symptoms of acute severe abdominal pain. She had a history of faint abdominal discomfort. Due to the acute deterioration of the abdominal pain a diagnostic laparoscopy was performed. A tumour arising from both ovaries was seen and a biopsy was taken in order to decide on further therapy. Histology showed a fibroid for which excision by a second laparoscopic intervention was planned. Due to excessive adhesions conversion to laparotomy was necessary.
  
  
  CONCLUSIONS
  We recommend that in the case of an abnormal adnexal mass, particularly in women who want to preserve their fertility, frozen section histology be performed laparoscopically. A frozen section diagnostic procedure, instead of a regular biopsy, seems to be a useful tool during an elective diagnostic laparoscopic procedure in order to prevent potential morbidity as a result of possible future laparoscopy or even laparotomy. Previous laparoscopic procedures can cause massive adhesions that could impede a subsequent laparoscopic approach.
authors.affiliation: Department of Gynecology, Bronovo Hospital, Postbus 96900, 2509 JH The Hague, The Netherlands. emgvesch@bronovo.nl
authors.forename: E M G
authors.initials: EM
authors.lastname: van Esch
authors.forename: S E
authors.initials: SE
authors.lastname: van Wijngaarden
authors.forename: H E
authors.initials: HE
authors.lastname: Schaafsma
authors.forename: M J G H
authors.initials: MJ
authors.lastname: Smeets
authors.forename: J P T
authors.initials: JP
authors.lastname: Rhemrev
mesh_terms: D000328:Adult; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D005629:Frozen Sections; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy; D010053:Ovary / Q000473:pathology