Background: A 24-year-old white female gravida 1, para 0010, presented with heavy vaginal bleeding and abdominal cramps of 2 weeks' duration. Medical history was remarkable for spontaneous abortion 5 years previously. She had no significant family history or other gynecological problems. Physical examination revealed tissue fragments and blood clots oozing from the cervical os, and her uterus was diffusely enlarged.
Investigations: Physical examination, ultrasound, uterine dilation and curettage, immunohistochemistry and human androgen receptor gene clonality analysis, uterine sonohistogram, MRI and exploratory laparotomy.
Diagnosis: Intrauterine dissemination of endometrial stromal tumors with smooth-muscle differentiation.
Management: Partial wedge resection of the anterior uterine wall via abdominal myomectomy and total abdominal hysterectomy.