Journal of Mid-life Health Journal of Mid-life Health
Home | About us | Editorial board | Search | Ahead of print | Current Issue | Past Issues | Instructions | Online submission | Subscribe | Advertise Users Online: 6  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size 




 
 Table of Contents 
CASE REPORT
Year : 2011  |  Volume : 2  |  Issue : 1  |  Page : 42-43  

Vaginal leiomyoma


1 Department of Pathology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India
2 Department of Gynecology and Obstetrics, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India

Date of Web Publication28-Jul-2011

Correspondence Address:
Indranil Chakrabarti
Department of Pathology, North Bengal Medical College, Sushrutanagar, Darjeeling - 734 012, West Bengal
India
Login to access the Email id


DOI: 10.4103/0976-7800.83274

PMID: 21897740

Get Permissions

   Abstract 

Leiomyomas are common benign tumors in the uterus. However, vaginal leiomyomas remain an uncommon entity with only about 300 reported cases. Here, we report a case of a 38-year-old multigravida who presented with lower abdominal pain and vaginal bleeding. A physical examination and ultrasonography were performed, and a diagnosis of cervical fibroid was made. Pervaginal removal of the tumor was performed and subsequent histopathology revealed a vaginal leiomyoma. Although a rare tumor, vaginal leiomyomas may present with a variety of clinical features and may be mistaken preoperatively for cervical fibroid. Removal of tumor by vaginal route, wherever possible, with subsequent histopathological examination appears to be the optimum management plan.

Keywords: Leiomyoma, vaginal tumour, benign uterine tumour


How to cite this article:
Chakrabarti I, De A, Pati S. Vaginal leiomyoma. J Mid-life Health 2011;2:42-3

How to cite this URL:
Chakrabarti I, De A, Pati S. Vaginal leiomyoma. J Mid-life Health [serial online] 2011 [cited 2014 Oct 21];2:42-3. Available from: http://www.jmidlifehealth.org/text.asp?2011/2/1/42/83274


   Introduction Top


Vaginal tumors are rare and include papilloma, hemangioma, mucus polyp, and rarely leiomyoma. Vaginal leiomyomas remain an uncommon entity with only about 300 reported cases since the first detected case back in 1733 by Denys de Leyden. [1] Bennett and Erlich [2] found only nine cases in 50,000 surgical specimens and only one case in 15,000 autopsies reviewed at Johns Hopkins Hospital. These tumors arise most commonly from the anterior vaginal wall causing varied clinical presentations. They may or may not be associated with leiomyomas elsewhere in the body. We report a case of primary leiomyoma of vagina arising from anterior wall and presenting with lower abdominal pain, bleeding, and a feeling of something coming out of vagina.


   Case Report Top


A 38-year-old female gravid 2, para 2 presented to the outpatient department with complaints of lower abdominal pain, abnormal vaginal bleeding, and dyspareunia since 8 months. There was no history of dysuria, increased frequency, or any feature of urinary retention. The patient complained that she noticed something appeared to come down her vagina for the last 2 months. A pervaginal examination revealed a mass in the vagina, but the upper limit of the mass could not be delineated. An ultrasonography was performed which showed a 6 × 4 cm hypoechoic mass in the upper part of vagina and a possibility of pedunculated cervical fibroid was made. There was no other abnormality on ultrasonography. The tumor was surgically removed by vaginal route. A Foley's catheter was introduced in the urethra for protecting the latter. The tumor was then sent for histopathological examination with a peroperative diagnosis of vaginal leiomyoma. Gross examination revealed a 6 × 5 cm solid mass with a whorling appearance in the cut section [Figure 1]. Microscopic examination revealed a well-circumscribed leiomyoma underlying the squamous epithelium, consistent with the diagnosis of vaginal leiomyoma [Figure 2].
Figure 1: Photograph showing the whorling pattern on cut section of the vaginal tumor

Click here to view
Figure 2: Microphotograph showing the leiomyoma (arrow) with the overlying vaginal squamous epithelium (right side) (hematoxylin and eosin stain, ×100 magnification)

Click here to view



   Discussion Top


Tumors of vagina are rare and there are only around 300 reported cases of vaginal leiomyomas since the first described case in 1733 by Denys de Leyden. [1] Leiomyomas in female genital tract are common in the uterus and to some extent in the cervix followed by the round ligament, utero-sacral ligament, ovary, and inguinal canal. [1] Occurrence in vagina is very rare. Vaginal leiomyomas are commonly seen in the age group ranging from 35 to 50 years and are reported to be more common among Caucasian women. [2] They usually occur as single, well-circumscribed mass arising from the midline anterior wall [1],[3] and less commonly, from the posterior and lateral walls. [4] They may be asymptomatic but depending on the site of occurrence, they can give rise to varying symptoms including lower abdominal pain, low back pain, vaginal bleeding, dyspareunia, frequency of micturation, dysuria, or other features of urinary obstruction These tumors can be intramural or pedunculated and solid as well as cystic. Usually these tumors are single, benign, and slow growing but sarcomatous transformation has been reported. [5] Preoperatively, diagnosis by ultrasonography may be difficult, but magnetic resonance imaging usually clinches the diagnosis. In magnetic resonance imaging, they appear as well-demarcated solid masses of low signal intensity in T1- and T2-weighted images, with homogenous contrast enhancement, while leiomyosarcomas and other vaginal malignancies show characteristic high T2 signal intensity with irregular and heterogeneous areas of necrosis or hemorrhage. [6],[7] However, histopathological confirmation is the gold standard of diagnosis and also beneficial to rule out any possible focus of malignancy. Surgical removal of the tumor through vaginal approach, preferably with urethral catheterization to protect the urethra during surgery, is usually the treatment of choice. In case of large tumors, however, an abdomino-perineal approach is preferred. The patient needs to be followed up for chance of recurrence. Our patient was symptom-free at 5-month follow-up.

 
   References Top

1.Young SB, Rose PG, Reuter KL. Vaginal fibromyomata: Two cases with preoperative assessment, resection and reconstruction. Obstet Gynecol 1991;78:972-4.  Back to cited text no. 1
    
2.Bennett HG Jr, Erlich MM. Myoma of the vagina. Am J Obstet Gynecol 1941;42:314-20.  Back to cited text no. 2
    
3.Shimada K, Ohashi I, Shibuya H, Tanabe F, Akashi T. MR imaging of an atypical vaginal leiomyoma. Am J Roentg 2002;178:752-4.  Back to cited text no. 3
    
4.Elsayes KM, Narra VR, Dillman JR, Velcheti V, Hameed O, Tongdee R, et al. Vaginal Masses: Magnetic Resonance Imaging Features with Pathologic Correlation. Acta Radiol 2007;8:921-33.  Back to cited text no. 4
    
5.Cobanoðlu O, Gürkan Zorlu C, Ergun Y, Kutluay L. Leiomyosarcoma of the vagina. Eur J Obstet Gynecol Reprod Biol 1996;70:205-7.  Back to cited text no. 5
    
6.BaeJ H, Choi SK, Kim JW. Vaginal leiomyoma: A case report and review of the literature. J Women's Med 2008;1:92-4.  Back to cited text no. 6
    
7.Shadbolt CL, Coakley FV, Qayyum A, Donat SM. MRI of vaginal leiomyomas. J Comput Assist Tomogr 2001;25:355-7.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed1228    
    Printed169    
    Emailed0    
    PDF Downloaded205    
    Comments [Add]    

Recommend this journal