Atypical Leiomyoma with Amianthoid-like Fibers (ALWAF), causing Rupture Uterus, Haemoperitoneum and Mortality- A Case Report

Atypical Leiomyoma with Amianthoid-like Fibers (ALWAF) is a very rare entity with a couple of cases in the literature. Amianthoid fibers are thick acellular mats composed of crystalline collagen fibers. This is an unusual case of a 53-year-old female with Chronic Kidney Disease (CKD), who presented with pain in the abdomen for three weeks. Computed Tomography (CT) showed a degenerated subserosal leiomyoma in the posterior wall of the uterus which had ruptured leading to haemoperitoneum. An emergency exploratory laparotomy with simple hysterectomy was done. Histopathology revealed a ruptured atypical leiomyoma with abundant amianthoid-like fibers. The patient expired seven days after surgery due to hypovolaemic shock. Rupture of the uterus in leiomyoma with amianthoid fibers has not been reported in the literature. Awareness of this entity is important in view of acute catastrophic consequences like haemoperitoneum, hypovolaemic shock, and death.