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

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.