Two Cases of Giant Uterine Leiomyomas With Myomatous Erythrocytosis Syndrome - Treated by Laparoscopic Hysterectomy

Sep 28, 2026

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Myomatous erythrocytosis syndrome (MES) is a rare condition defined by erythrocytosis, uterine leiomyomas, and rapid hematologic normalization after tumor removal. Two postmenopausal women with giant uterine leiomyomas complicated by MES were managed with total laparoscopic hysterectomy using in-bag morcellation for safe specimen retrieval. Hemoglobin, hematocrit, and serum erythropoietin (EPO) decreased promptly postoperatively. Despite large tumor sizes, both cases demonstrated only upper-normal serum EPO, suggesting tumor weight may not directly correlate with EPO secretion.

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CategoryHealthcare

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Abstract

Introduction

Case Presentation

Case 1

Case 2

How to cite this article

Review began 10/26/2025 Review ended 11/28/2025 Published 12/03/2025 © Copyright 2025 Aimoto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98374 Open Access Case Report Two Cases of Giant Uterine Leiomyomas With Myomatous Erythrocytosis Syndrome Treated by Laparoscopic Hysterectomy Noritoshi Aimoto 1 , Takashi Matsumoto 1 , Yonosuke Tsuda 1, Hosokawa Yumi 1 1. Gynecology, Osaka Central Hospital, Osaka, JPN Corresponding author: Noritoshi Aimoto, [aimoto.nori@gmail.com](aimoto.nori@gmail.com) Abstract Myomatous erythrocytosis syndrome (MES) is a rare condition characterized by erythrocytosis, the presence of uterine leiomyomas, and the rapid normalization of hematologic parameters following tumor removal. Ectopic erythropoietin (EPO) production by the tumor is considered the main cause. We encountered two postmenopausal women with giant uterine leiomyomas complicated by MES. Case 1 involved a 21-cm subserosal leiomyoma, and Case 2 involved a 14-cm intramural leiomyoma. We performed total laparoscopic hysterectomy with in-bag morcellation in both cases, enabling safe specimen retrieval. Postoperatively, hemoglobin, hematocrit, and serum EPO levels decreased promptly. Despite the large tumor size, both patients showed only upper-normal serum EPO concentrations, suggesting that tumor weight does not necessarily correlate with EPO secretion. Categories: Obstetrics/Gynecology, Oncology Keywords: erythropoietin, erythropoietin producing uterine myoma, myomatous erythrocytosis syndrome, tlh, total laparoscopic hysterectomy Introduction Uterine fibroids are the most common benign gynecological tumors, occurring in up to 70% of women by age 50 [1] . The primary reasons for treatment intervention are anemia symptoms associated with menorrhagia, compression symptoms caused by fibroids, and dysmenorrhea [2, 3]. However, in rare cases, uterine fibroids may be complicated by polycythemia. Myomatous erythrocytosis syndrome (MES) is a rare tumor-associated condition first reported in 1953. It is defined by three hallmarks: erythrocytosis, histologically confirmed smooth muscle tumors, and rapid normalization of hematologic parameters following tumor resection [4, 5]. We believe the principal mechanism underlying MES is the ectopic production of erythropoietin (EPO) by the leiomyoma tissue itself. Immunohistochemical staining and mRNA analysis in resected tumors support this finding [6, 7]. This unregulated hormone production leads to an overproduction of red blood cells, which significantly increases the risk of thromboembolic events such as stroke and pulmonary embolism. This risk makes diagnosis and treatment crucial even in asymptomatic patients [8] . The standard treatment for MES is surgical excision of the tumor, commonly via hysterectomy. Historically, laparotomy was frequently selected because MES is often associated with giant leiomyomas [5, 7]. However, advances in minimally invasive surgery now allow for laparoscopic management in selected patients, offering reduced morbidity and shorter recovery times [9] . The objective of this report is to present two postmenopausal women with giant leiomyomas complicated by MES, highlight key diagnostic considerations (including preoperative exclusion of leiomyosarcoma in large postmenopausal masses), and demonstrate the safety and feasibility of total laparoscopic hysterectomy with contained morcellation. Case Presentation Case 1 A 60-year-old, postmenopausal, nulliparous woman presented with a chief complaint of progressive abdominal distension over several months. Her past medical history was significant for hypertension, which was well-controlled with amlodipine (5 mg/day) . On physical examination, we palpated a large

FAQs

What are the key features that define myomatous erythrocytosis syndrome (MES)?

MES is characterized by erythrocytosis, uterine leiomyomas confirmed histologically, and rapid normalization of hematologic parameters after tumor resection.

What is the suspected main mechanism of MES in these cases?

The report describes ectopic erythropoietin (EPO) production by the leiomyoma tissue, which leads to increased red blood cell production and elevated thromboembolic risk.

How were the two patients treated and what happened to hematologic parameters after surgery?

Both patients underwent total laparoscopic hysterectomy with in-bag morcellation. After surgery, hemoglobin, hematocrit, and serum EPO levels decreased promptly, with normalization within about one month in the presented table for Case 1.

Sep 28, 2026

Upload by Sarah