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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 6  |  Issue : 2  |  Page : 127-129

Vaginal myomectomy of a huge prolapsed cervical leiomyoma


Department of Obstetrics and Gynaecology, Barau Dikko Teaching Hospital, Faculty of Medicine, Kaduna State University, Kaduna State, Nigeria

Date of Web Publication30-Nov-2016

Correspondence Address:
Matthew C Taingson
Department of Obstetrics and Gynaecology, Barau Dikko Teaching Hospital, Faculty of Medicine, Kaduna State University, Kaduna State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.194985

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  Abstract 

Cervical myomas arise from the smooth muscle cells of the cervix accounting for 2% of all uterine leiomyomas. This is a case report of a 31-year-old lady who presented with a white, watery vaginal discharge, and a 6-hour history of protrusion per vaginam. Examination revealed a progressively increasing mass protruding per vaginam. She underwent a vaginal myomectomy, and a leiomyoma 13 × 12 × 7 cm with areas of necrosis was removed. She did well postoperatively. Vaginal myomectomy is an effective procedure for patients with huge leiomyomas.

Keywords: Prolapsed cervical leiomyoma, vaginal myomectomy


How to cite this article:
Taingson MC, Adze JA, Bature SB, Amina DM, Caleb M, Amina A. Vaginal myomectomy of a huge prolapsed cervical leiomyoma. Arch Int Surg 2016;6:127-9

How to cite this URL:
Taingson MC, Adze JA, Bature SB, Amina DM, Caleb M, Amina A. Vaginal myomectomy of a huge prolapsed cervical leiomyoma. Arch Int Surg [serial online] 2016 [cited 2021 Jan 16];6:127-9. Available from: https://www.archintsurg.org/text.asp?2016/6/2/127/194985


  Introduction Top


Cervical myomas arise from the smooth muscle cells of the cervix and account for 2% of all uterine leiomyomas.[1] They can affect the supravaginal or vaginal portion of the cervix. Cervical fibroids are classified as anterior, posterior, lateral, and central depending on their site of origin. Each fibroid presents differently.[2] Frequently, they present with retention of urine, menstrual abnormalities, coital problems, and constipation. Occasionally, they are asymptomatic.[1],[2]


  Case Report Top


A 31-year-old para 0+0, single female presented at the Barau Dikko Teaching Hospital Kaduna State, Nigeria, on the 21st of January 2016, with a 6-hour history of a mass protruding from the vagina. She had felt the mass in the vagina 6 months prior to the presentation, however, this was the first time it had protruded from the introitus. As a result she suffered discomfort when walking. She also gave a history of copious, watery, whitish, and non-foul smelling vaginal discharge of 1 year duration. There was associated, dull abdominal pain but no abnormal vaginal bleeding and no urinary symptoms.

She was seen in the gynecology clinic 4 months prior to the presentation and noted to have a large cervical leiomyoma. She was scheduled for surgery but she declined.

She attained menarche at the age of 13 years. Her menstrual cycle was every 4 weeks and lasted 5 days. Her last menstrual period was 3 weeks (30/12/15) before the presentation. She had no prior problems with irregular or heavy menses.

On examination, she was a young lady, anxious, afebrile (37°C), anicteric, and not pale. There was no pedal edema. The respiratory rate was 22 cycles/min. Her pulse rate was 90 beats/min, regular, and good volume; blood pressure was 110/70 mmHg.

Abdominal examination revealed no abnormalities. Pelvic examination revealed a large spherical, pinkish mass that protruded from the vagina (13 × 12) cm, which was firm in consistency, with necrosis at its distal end. The mass had a stalk that measured 4 cm in length and 3 cm in width arising from the inner part of the cervix on the left. Copious whitish non-foul smelling discharge was noted around the vulva [Figure 1]a and [Figure 1]b. The clinical impression was of a cervical polyp. On investigation, her hematocrit was 31%, and her serum electrolytes, urea, and creatinine levels were within normal limits. She was negative for hepatitis B surface antigen, hepatitis C virus, and human immunodeficiency virus (HIV). Abdominopelvic scan showed an empty uterus AP diameter of 4 cm, with endometrial plate visualized, adnexae normal.
Figure 1: (a and b) A huge prolapsed fibroid polyp

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She underwent vaginal myomectomy under general anesthesia on the 26th of January 2016. The intraoperative findings included a prolapsed leiomyoma that weighed 450 g and a hypertrophied cervix. The prolapsed leiomyoma was removed in one piece after clamping the pedicle and twisting it off. The base of the pedicle was ligated with vicryl no 1. The estimated blood loss was 250 ml. Her postoperative recovery was satisfactory. She was discharged on postoperative day 4. She was seen at the gynecology outpatient clinic 3 weeks after the surgery and her clinical condition was satisfactory. The histopathological report was as follows;

Macroscopy: A well-circumscribed grey brown tissue with a pedicle and a glistening surface. It measures 13 × 12 × 7 cm and weighed 429 g. The cut section showed grey brown and tan solid and cystic areas. The cyst contain hemorrhagic material PEx8.

Microscopy: Section showed a leiomyoma with surface necrotic debris, focal marked edema, and focal ischemic infarction marked neutrophil infiltrates.

Conclusion: Cervical polyp-inflamed leiomyoma with ischemic infarction.


  Discussion Top


Cervical leiomyoma is the most common cervical benign tumor. A cervical myoma is usually solitary in contrast to uterine myomas,[3] as in this case.

Occasionally, a cervical myoma may become pedunculated and protrude through the external orifice of the cervix. These prolapsed myomas may be ulcerated due to inadequate blood circulation through a long pedicle.[4] Similar finding was noted in the myoma removed from the patient. This change on the myoma can mimic a malignant tumor.[4] Other pathology simulating cervical myoma include cystocele,[5] chronic uterine inversion,[6] and rarely vaginal tumors.[7]

The patient had vaginal myomectomy because she was nulliparous and no other fibroid seedling was found. This has been recommended as the initial treatment of choice.[8] Other treatment modalities include hysteroscopic myomectomy in cases of small myomas and with the pedicle being accessible.[9] Patients who have completed their family and not keen to preserve uterus, vaginal hysterectomy is a treatment option and preferable to abdominal hysterectomy.[10]


  Conclusion Top


In conclusion, huge prolapsed cervical fibroid is discomforting, but rare, and can be successfully removed vaginally with minimal morbidity.[11]

Acknowledgement

The authors would like to express gratitude to Prof. Lydia Airede for her critical reading and comments on the case report.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Tiltman AJ. Leiomyomas of the uterine cervix: A Study of frequency. Int J Gynecol Pathol 1998;17:231-4.  Back to cited text no. 1
    
2.
Keriakos R, Maher M. Management of Cervical Fibroid during the Reproductive Period. Case Rep Obstet Gynecol 2013;2013:984030.  Back to cited text no. 2
    
3.
El-agwany AS. Lipoleiomyoma of the uterine cervix: An unusual variant of uterine leiomyoma. Egyptian J Radiol Nucl Med 2015;46:211-3.  Back to cited text no. 3
    
4.
Sengupta S, Reddy K, Pillai M. Prolapsed cervical fibroid in pregnancy: A challenging obstetric dilemma. J Obstet Gynaecol 2006;26:823-4.  Back to cited text no. 4
    
5.
Jaouad K, Youssef B, Hanane R, Driss M, Mohamed D. Huge prolapsed cervical myoma mimicking cystocele. Saudi J Health Sci 2015;4:135-7.  Back to cited text no. 5
  Medknow Journal  
6.
Singh S, Chaudhary P. Central cervical fibroid mimicking as chronic uterine inversion: A case report. Int J Reprod Contracept Obstet Gynecol 2013;2:687-8.  Back to cited text no. 6
    
7.
Chakrabarti I, De A, Pati S. Vaginal leiomyoma. J Midlife Health 2011;2:42-3.  Back to cited text no. 7
    
8.
BenBaruch G, Schiff E, Menashe Y, Menczer J. Immediate and late outcome of vaginal myomectomy for prolapsed pedunculated submucous myoma. Obstet Gynecol 1988;72:858-61.  Back to cited text no. 8
    
9.
Vilos GA, Allaire C, Laberge PY, Leyland N, Vilos AG, Murji A, et al. The management of uterine leiomyomas. J Obstet Gynaecol Can 2015;37:157-81.  Back to cited text no. 9
    
10.
Benassi L, Rossi T, Kaihura CT, Ricci L, Bedocchi L, Galanti B, et al. Abdominal or vaginal hysterectomy for enlarged uteri: A randomized clinical trial. Am J Obstet Gynecol 2002;187:1561-5.  Back to cited text no. 10
    
11.
Golan A, Zachalka N, Lurie S, Sagir R, Glezerman M. Vaginal removal of prolapsed pedunculated submucous myoma: A short, simple, and definitive procedure with minimal morbidity. Arch Gynecol Obstet 2005;271:11-3.  Back to cited text no. 11
    


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Abstract
Introduction
Case Report
Discussion
Conclusion
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