A Misdiagnosed Vaginal Leiomyoma: Case Report

Leiomyoma presenting as an anterior vaginal mass

Leiomyoma, otherwise known as a fibroid, is commonly encountered in the uterus. Vaginal leiomyomas are extremely rare with a relative paucity of cases reported in the literature. Due to the rarity of the disease and complexity of the vaginal anatomy, definitive diagnosis and treatment are challenging. The diagnosis is often only made postoperatively after resection of the mass. They usually arise from the anterior vaginal wall and women may present with dyspareunia, lower abdominal pain, vaginal bleeding or dysuria. Imaging with a transvaginal ultrasound scan and MRI can confirm the vaginal origin of the mass. Surgical excision is the treatment of choice. The diagnosis is confirmed following histological assessment. The authors present the case of a woman in her late 40s presenting to the gynaecology department with an anterior vaginal mass. Further investigation with a non-contrast MRI was suggestive of a vaginal leiomyoma. She underwent surgical excision. Histopathological features were in keeping with the diagnosis of a hydropic leiomyoma. A high index of clinical suspicion is required to establish the diagnosis as it can be mistaken for a cystocele, Skene duct abscess or Bartholin gland cyst. Although it is a benign entity, local recurrence following incomplete resection and sarcomatous changes have been reported.

Vaginal leiomyoma mimicking a Cystocele (report case)

Introduction and importance

Case presentation

Clinical discussion

Conclusion

GnRH analogue followed by surgery in treatment of vaginal leiomyoma-a case report

RATIONALE

Vaginal leiomyoma is a rare type of leiomyoma that occurs on the wall of vagina. Treatment for vaginal leiomyoma is varied and is based on the location and size of the leiomyoma.

PATIENT CONCERNS

In this case, a 24-year-old newly married Chinese woman complained of dyspareunia. The physical examination revealed a solid mass on the anterior wall of vagina. It almost filled up the whole vagina cavity.

DIAGNOSIS

Transvaginal ultrasound showed a tumor on the anterior wall of vagina. Pelvic computed tomography (CT) and magnetic resonance imaging (MRI) also confirmed the tumor on vaginal wall. Fine needle aspiration biopsy confirmed fibrous and smooth muscle tissue in the tumor, and immunohistochemical examination found the estrogen receptor (ER) and progesterone receptor (PR) were positive.

INTERVENTIONS

6 courses of gonadotropin-releasing hormone (GnRH) analogue were given before the patient underwent complete surgical resection through vagina.

OUTCOME

No postoperative complications occurred, and the patient was discharged from the hospital 3 days after surgery. Follow-up after 3 months revealed negative symptoms of genitourinary system. No sign of recurrence was found.

CONCLUSION

In this case, vaginal leiomyoma was diagnosed with help of imagological examinations like ultrasound, CT, and MRI, as well as pathological examination like fine needle aspiration biopsy. Preoperative GnRH analogue treatment can ensure smooth surgical procedure, and reduce blood loss during surgery.

What is this vaginal bulge? An atypical case of vaginal paraurethral leiomyoma. A case report and literature systematic review

AIM

Vaginal paraurethral leiomyomas are uncommon benign tumors of the female genitourinary tract. We report a case of anterior vaginal paraurethral leiomyoma. Furthermore, we performed a systematic review of the literature to provide information that can help the physicians in the diagnosis and management of women with this rare pathology.

METHODS

A case of anterior vaginal paraurethral leiomyoma in 53-year-old, primiparous, caucasian woman with history of pelvic pressure, vaginal bulging and overactive bladder symptoms, was described. Furthermore, a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was performed between January 1, 2000 to Dec 30, 2019. Only articles that reported cases of vaginal or paraurethral leiomyoma (b) case series and case reports with literature review were included.

RESULTS

we screened a total 2281 records; 70 articles published from 2000 to 2019 were included.

CONCLUSION

Vaginal paraurethral leiomyoma is a rare benign tumor of the vagina with a wide spectrum of symptoms and good prognosis. The recurrence and transformation into malignant condition are rare. Histopathological examination is the gold standard for diagnosis, but MRI and US can be help to define the size and localization of the tumor. Management requires surgical vaginal excision in the majority of cases; however, abdominal approach could be considered when it is large and located high in the vagina.

Vaginal leiomyoma: medical imaging and diagnosis in a resource low tertiary hospital: case report

Background

In the literature under review there are about 300 reported cases of vaginal leiomyomas with none from Cameroon. We report a case of vaginal leiomyoma and highlight the diagnostic challenges faced at the Douala Referral Hospital (DRH), Cameroon.

Case presentation

A 36-year-old G3P3002 sexually active Cameroonian married woman reported dysuria, dyspareunia, cessation of sexual intercourse and offensive smelling vaginal discharge for 6 months and a 3-year history of a vaginal tumour; she was misdiagnosed despite ultrasonography and magnetic resonance imaging (MRI) but was corrected by an experienced radiologist. She underwent first look laparoscopy, surgical excision of the tumour through the vagina and histopathology analysis that confirmed leiomyoma.

Conclusion

Posterior location of vaginal leiomyomas found in this case is a rare occurrence. The diagnosis is based on careful examination and preoperative imaging (ultrasonography and MRI). However, the definitive diagnosis is usually made intra-operatively. We combined laparoscopic exploration of the internal genital organs and per vaginal excision of the vaginal leiomyoma. Thus, we recommend frozen section biopsy to exclude leiomyosarcoma.