A Rapidly Growing Paraurethral Myoma with Profuse Bleeding from a Mucosal Vessel: Report of a Case

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.

Urethral Leiomyoma: A Rare Clinical Entity

Extrauterine leiomyomas are encountered occasionally, which can pose a diagnostic dilemma and challenge to the gynaecologist. We report a rare case of urethral leiomyoma. A 31-year-old woman with history of primary subfertility presented with mass at her urethral meatus and lower urinary tract symptoms. She underwent examination under anaesthesia and excision of the urethral mass. Histopathological examination confirmed leiomyoma. Diagnosis and management of this common growth situated at a rare location were reviewed and discussed.

Leiomyoma: a case report of a rare benign tumor of the female urethra

Leiomyoma is a benign smooth muscle tumor which is rarely found in urethra. It often appears in females during their reproductive age (from menarche to menopause); the mean age of their appearance is approximately 41 years. Less than 100 cases were reported in the literature. We hereby report a case of a 52-year-old White woman who presented with complaints of dysuria and urinary tract infection. The mass was completely removed by transvaginal excision with a rim of normal tissue. Histopathological studies confirmed the urethral leiomyoma. The patient remained asymptomatic and there was no evidence of recurrence in the followup.

Female paraurethral leiomyoma: treatment and long-term follow-up

INTRODUCTION

We describe our experience with evaluating the ideal management of female paraurethral leiomyomas from imaging to surgery and follow-up.

METHODS

Between January 2009 and January 2012, we treated six women (age range 32-49 years) affected by paraurethral leiomyoma of different sizes.

RESULTS

All the six patients underwent transvaginal excision of the mass. They are free of recurrence at follow-up (range 32-72 months). Two patients developed stress urinary incontinence after the excision: in both cases, incontinence was corrected by a tension-free vaginal tape-obturator (TVT-O) placement. In one patient, a fascial sling was necessary to repair a urethral lesion that developed during surgical excision of the mass.

CONCLUSION

A well-defined protocol for diagnosing and managing a paraurethral mass had not been established as yet due the rarity of the mass. We suggest performing pelvic magnetic resonance imaging (MRI) as a primary examination, followed by lesion biopsy. Complete surgical resection performed transvaginally should be the treatment of choice. As paraurethral leiomyomas does not originate from intraurethral smooth-muscle component, urethral lesion is rare. Excision of female urethral leiomyoma transvaginally is safe, and postoperative urinary incontinence, if any, can be easily corrected with minimally invasive tecniques.

Paraurethral leiomyoma in a postmenopausal woman: first European case

Leiomyomas are benign tumors extending from smooth muscle cells and only few cases of paraurethral leiomyomas have been described in the literature. They are often seen in the reproductive age and around 50% of the cases are asymptomatic. We describe a 59-year-old woman with a solid mobile tumor below the symphysis revealed at a gynecological examination. Transvaginal ultrasound and MRI confirmed the tumor and excision of the paraurethral tumor was carried out. The histological examination showed a benign paraurethral leiomyoma. The postoperative period was characterized by urethral pain as well as vaginal leakage of urine.

[Not Available]

Le léiomyome de l’urètre est une tumeur bénigne rare constituée detissus musculaires lisses. Cette tumeur se traduit par une variété designes cliniques ; le recours à l’histologie est donc nécessaire pourposer le diagnostic. Le traitement de choix est l’exérèse chirurgicale.Aucun cas de dégénérescence maligne n’a été signalé jusqu’àprésent, mais une récidive locale est possible en cas d’exérèseincomplète. Les auteurs font état d’un nouveau cas de léiomyomeintéressant à la fois le col vésical et l’urètre, et se traduisant par ladysurie chez une patiente ; ils proposent également une revue dela littérature concernant cette pathologie.

Leiomyoma--a rare benign tumor of the female urethra: a case report

INTRODUCTION

Leiomyoma in the urethra is a rare occurrence. These are rare benign mesenchymal tumors that arise from the smooth muscle of the urethra. Such tumors often appear in females during their reproductive age (from menarche to menopause); the mean age of their appearance is approximately 41 years.

CASE PRESENTATION

We report here a case of a 52-year-old White woman who presented with complaints of sporadic hematuria, dyspareunia, and feeling of nodulation in her vagina.

CONCLUSIONS

Histopathological studies confirmed the urethral leiomyoma, and the surgery completely resolved the original symptoms. Although the average age of occurrence of such tumors in females is about 41 years, the present case involves an older woman of 52 years. Most importantly, the mass was located in the distal urethra, an uncommon site of presentation of leiomyoma in females.

Lesions of Skene glands and periurethral region: a review

The periurethral (Skene) glands may become involved by a variety of conditions. Mass-like lesions need to be distinguished from other lesions arising from the anterior vagina. Familiarity with these lesions will be helpful if a patient with a lesion of the Skene glands or periurethral region is encountered.

Leiomyoma of the female urethra-a rare tumor: case report and review of the literature

Leiomyoma is a benign smooth muscle tumor which is rarely found in urethra. Only a handful of cases have been reported in the literature. We hereby report a case of urethral leiomyoma in a twenty-seven-year-old female who presented with intermittent hematuria. Mass was completely excised with a rim of normal tissue. Patient remained asymptomatic with no evidence of recurrence in followup.

Large symptomatic periurethral cystic lesion in a male

We report an unusual case of a periurethral cystic mass in a 43-year-old man who presented with perineal pain, dysuria, painful ejaculation, and post-ejaculatory lower urinary tract symptoms. Computed tomography and magnetic resonance imaging demonstrated a multiocular periurethral cystic structure. On surgical exploration of the urethra, a cystic lesion was identified and removed. The mass was classified as a complex periurethral cyst from the histopathologic findings.

A leiomyoma presenting as an exophytic periurethral mass: a case report and review of the literature

Periurethral masses in females are rarely observed, although they can occur anywhere along the genitourinary tract. They may be detected on physical examination or present with symptoms such as vaginal swelling, bladder outlet obstruction, vaginal bleeding, hematuria, or urinary tract infection. We report a sexually inactive, 27-year-old woman with an exophytic, fimbria-like periurethral mass. The benign nature of the lesion was suspected on the basis of the findings of magnetic resonance imaging. Surgical enucleation was performed. The microscopic examination revealed a urethral leiomyoma. Immunohistochemical study confirmed a leiomyoma with positive staining for smooth muscle actin and negative staining for S-100.

Leiomyomas of the female urethra and bladder: a report of five cases and review of the literature

Through the experience of five cases of leiomyoma developed in the female bladder and urethra with a review of the literature, we have made an effort to characterize the association of symptom with the size and location of the tumor and demonstrate an appropriate treatment. The study population was composed of patients who underwent surgery for bladder or urethral leiomyoma in our hospital from March 1990 to April 2005. Their medical records were reviewed retrospectively concerning the symptom, size and location of leiomyoma, the result of cystoscope and radiological examination, surgical method, pathologic report, complications, and recurrence. Four cases were diagnosed as urethral leiomyoma and one case as bladder leiomyoma. All patients with urethral leiomyoma were admitted for the chief complaint of a palpable tumor. When the tumor size was small, if it was located on the lateral side of the urethra, it was asymptomatic, but if located in the midline, it presented irritative or obstructive symptom. When it was big, if located on the lateral side, it presented irritative rather than obstructive symptom, and if located in the midline, it presented obstructive symptom. One case of bladder leiomyoma was discovered incidentally during ultrasonic exam. In all five cases, surgical removal was performed and complications or recurrence were not detected afterwards. Bladder and urethral leiomyomas are very rare and cause diverse manifestations from asymptomatic to irritative or obstructive symptom. It is presumed that the location and size of the tumor are associated with symptom. Unless it is the case with severe hemorrhage or obstructive acute renal failure, immediate surgery is not required. However, it is desirable to distinguish leiomyoma from malignant or other benign tumors by surgical biopsy or removal.