Background: Intramural isthmic-cervical leiomyomas (ICLs) can reach massive size and cause extreme discomfort. Surgical removal of these leiomyomas is technically challenging, with an increased risk of operative complications. Cases: In this article, we present 2 cases of large, circumferential, intramural ICL necessitating surgical intervention. Both cases required radical dissection of the pelvis to ensure successful hysterectomy. Conclusions: Radical pelvic dissection at the time of hysterectomy is necessary in most cases of large intramural ICLs to minimize the risk of intraoperative complications. (J GYNECOL SURG 26:53)
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