Acute non-puerperal uterine inversion caused by a giant uterine leiomyoma with angioleiomyomatous features: A case report

Non-puerperal uterine inversion is an extremely rare condition most often associated with uterine tumors. A 48-year-old woman presented with sudden vaginal bleeding and a large protruding mass. Emergency surgery revealed complete uterine inversion caused by a giant pedunculated mass arising from the uterine fundus. The tumor was excised vaginally, and the uterus was manually repositioned. Because multiple fibroids were also present and fertility was not desired, a total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathological examination revealed a leiomyoma with prominent angioleiomyomatous features, characterized by spindle cells surrounding thick-walled vascular structures and immunopositivity for desmin, smooth muscle actin, and progesterone receptor. The postoperative course was uneventful, and no recurrence was observed during 60 months of follow-up. This case highlights a rare morphological variant of uterine leiomyoma presenting with acute non-puerperal inversion and emphasizes the importance of early recognition and prompt surgical management.