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

## TL;DR

Two postmenopausal women with large uterine tumors and high red blood cell counts were successfully treated with laparoscopic surgery, showing rapid improvement in blood parameters.

## Contribution

Demonstrates successful laparoscopic treatment of giant uterine leiomyomas with MES and notes that tumor size may not correlate with EPO levels.

## Key findings

- Laparoscopic hysterectomy with in-bag morcellation safely removed large uterine tumors.
- Hematologic parameters normalized quickly after surgery in both patients.
- Tumor weight did not strongly correlate with serum EPO levels in these cases.

## 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.