Leiomyoma remaining after vaginal hysterectomy for symptomatic leiomyomas. A case report

BACKGROUND: A remaining leiomyoma, an uncommon postoperative complication of vaginal hysterectomy for symptomatic leiomyomas, occurred. CASE: A second vaginal operation for a remaining leiomyoma was necessary 1 month after a vaginal hysterectomy for a myomatous uterus. CONCLUSION: Checking the pelvic cavity during hysterectomy may avoid this complication.     

Efficacy of ulipristal acetate (UPA) for the treatment of expulsion uterine myomas: report of two cases

Abstract

Expulsion leiomyoma can represent an emergency condition and may lead to severe vaginal hemorrhage with anemia and urgent hysterectomy. Among medical treatments used for leiomyoma, Selective progesterone receptor modulators (SPRM) and, in particular, Ulipristal Acetate (UPA) have been proved to be effective in the management of bleeding and myoma size reduction. However, to our knowledge, there are no cases reported in literature on the use of UPA used as ‘emergency’ medical therapy in patients with severe anemia and vaginal bleeding due to expulsion leiomyoma. In this paper we would report two cases of patients affected by expulsion myoma successfully treated with UPA with immediate resolution of vaginal bleeding and subsequent elective conservative treatment.     

A rapidly growing paraurethral myoma with profuse bleeding from a mucosal vessel: report of a case

Paraurethral leiomyoma is rare. This is the first reported case of a woman with a 6 x 7 x 5 cm urethral leiomyoma with profuse vaginal bleeding. The site of bleeding was identified as the anterior vaginal mucosal vein, which we subsequently electrocauterized. Enucleation of the mass was performed smoothly with a Foley catheter to avoid damage to the urethra. Profuse bleeding from a paraurethral myoma is possibly due to increased vascularity and the prolapsed nature of the tumor in this area.     

Recurrent leiomyoma of the vagina.

A rare case of huge vaginal leiomyoma recurrence is reported. Vaginal leiomyoma is a rare entity and recurrence after its removal is extremely rare. However, if recurrence occurs with intact ovarian function ovariectomy should also be done.     

Vaginal wall fibroid

Localization of leiomyomas in the vaginal wall is very rare. We report about a case of a vaginal leiomyoma in the anterior vaginal wall, preoperatively identified with sonography and CT. Surgical enucleation was performed. Surgical removal in these cases is safe and usually with minimal bleeding.     

Leiomyoma uteri in a rudimentary uterine horn in a woman with the Rokitansky-Kuster-Hauser syndrome. A case report

A 4-cm leiomyoma was found in a woman with the Rokitansky-Kuster-Hauser syndrome. It was discovered six years after she presented to a gynecologist. In the ensuing years she successfully developed vaginal dilation. This is the fourth reported case of leiomyoma associated with the Rokitansky-Kuster-Hauser syndrome.     

Laparoscopic removal of a bladder leiomyoma

Bladder leiomyoma is a rare tumor that is generally removed by transabdominal, vaginal, and transurethral approaches. We successfully removed a large, transmural, extravesical bladder leiomyoma by laparoscopy.     

Non-puerperal incomplete lateral uterine inversion with submucous leiomyoma: a case report

A perimenopausal, multiparous woman presented with prolapse. Clinically, there was a doubt between prolapsed submucous leiomyoma and uterine inversion. Laparoscopy showed an unusual pattern of uterine inversion restricted to the left cornual region with a submucous leiomyoma. A vaginal hysterectomy with due considerations for alterations of anatomical relationships minimized operative morbidity.     

Vaginal tumors in pregnancy. Case report and review of the literature

A young patient with a vaginal tumor in early pregnancy is presented. The difficulty in diagnosis and subsequent management is discussed. Vaginal tumors with special reference to vaginal leiomyoma are reviewed and a differential diagnosis is presented.     

Vaginal leiomyoma

Vaginal leiomyoma is a very rare condition. The earliest reference made to such a tumor is attributed to Denys De Leyden in 1773, and the first review of the literature concerning such tumors was published in 1882. It is estimated approximately 300 leiomyomas of the vagina have been reported in the world literature. The case of a 39-year-old female with large vaginal leiomyoma illustrates the diagnostic difficulties in such cases. In leiomyoma of the vagina surgical treatment is recommended.     

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.     

Removal of a vaginal leiomyoma presenting as tumor previa allowing vaginal birth

Leiomyomas of the vagina are very rare tumors of the female genital tract with only 300 cases reported so far. A case of removal of the vaginal leiomyoma presenting as tumor previa in advanced pregnancy is described. Removal of the tumor allowed vaginal birth three weeks after surgery.     

Laparoscopic management of a pelvic retroperitoneal leiomyoma—case report

Leiomyomas are benign tumors frequently found in the fourth and fifth decades of life. Although the uterus is the most common site of origin of leiomyomas, they can develop at any site where there is smooth muscle cell. Extrauterine leiomyomas are not common and usually their diagnostic are more challenging. In this paper, we report one case of pelvic retroperitoneal leiomyoma associated to vulvar/perineal leiomyomas. A 47-year-old female patient presented with a 6-month history of deep dyspareunia, abdominal pain, dysuria, and pain during defecation. She had a previous history of two open myomectomies, a supracervical hysterectomy associated to the exeresis of a vulvar leiomyoma, and a left salpingo-oophorectomy. On vaginal examination, there was a tender and firm mass at the vaginal vault and along the posterior vaginal wall. There was another tumor at the left vulvar/perineal region measuring around 6 cm. Magnetic resonance imaging demonstrated the presence of a mass at the Douglas pouch measuring 14 × 10 × 10 cm suggestive of uterine leiomyomatosis. She underwent a successful laparoscopic resection of the pelvic tumor with an operative time of 210 min. The vulvar/perineal lesions were resected by vaginal approach. She presented an uneventful postoperative course and was discharged home 3 days after surgery. Histopathology confirmed the diagnosis of leiomyomas. Laparoscopic approach for pelvic retroperitoneal leiomyoma is feasible. It is important to keep in mind the possibility of this entity as a differential diagnosis of retroperitoneal masses in women.     

Laparoscopic Enucleation of a Bladder Leiomyoma

Bladder leiomyomas account for less than 0.43% of all bladder tumors, and these comprise about 35% of mesenchymal tumors 1, 2. About 250 cases of bladder leiomyoma have been reported in the English literature to date [3]. A patient may or may not have symptoms, according to the location and size of the leiomyoma. Initial symptoms include urinary frequency, urgency, hematuria, and pelvic pain [4]. Treatment for bladder leiomyoma includes abdominal, vaginal, laparoscopic, or transurethral resection. Herein, we present the first case, to our knowledge, of bladder leiomyoma that was laparoscopically enucleated without cystotomy.     

Non-puerperal uterine inversion. Report of a case

Non-puerperal uterine inversion is extremely rare. We report a case associated with leiomyoma. It is presented the case of a multiparous of 46 year-old for presenting severe vaginal bleeding, pelvic pain and strange body vaginal sensation. The diagnosis was uterine myoma in abortive phase. An abdominal hysterectomy was performed to find a complete uterine inversion. This report represents an anecdotal case of non-puerperal uterine inversion successfully treated surgically.     

Leiomyoma of the vagina: an unusual presentation

Vaginal leiomyomas are rare. They usually arise from the anterior vaginal wall. We report a case of a vaginal leiomyoma arising from the right lateral wall that presented as a gluteal swelling with pus discharging per vagina, creating a clinical dilemma in diagnosis. Preoperative imaging and biopsy may help to rule out malignancy. The size of the tumor necessitated abdominoperineal approach and hysterectomy for better surgical access. To the best of our knowledge such a clinical presentation of a vaginal leiomyoma has not been reported in the literature.     

Effect of maternal age on blood loss during parturition: a retrospective multivariate analysis of 10,053 cases

OBJECTIVE: An extensive study as to whether maternal age itself is a risk factor for blood loss during parturition. METHOD: A total of 10,053 consecutive women who delivered a singleton infant were studied. The excess blood loss was defined separately for women with vaginal and cesarean deliveries as > or = 90th centile value for each delivery mode. The effects of 13 potential risk factors on blood loss were analyzed using multivariate analysis. RESULTS: The 90th centile value of blood loss was 615 ml and 1,531 ml for women with vaginal and cesarean deliveries, respectively. A low lying placenta (odds ratio [OR], 4.4), previous cesarean (3.1), operative delivery (2.6), leiomyoma (1.9), primiparity (1.6), and maternal age > or = 35 years (1.5) were significant independent risk factors for excess blood loss in women with vaginal delivery. Placenta previa (6.3), leiomyoma (3.6), low lying placenta (3.3), and maternal age > or = 35 years (1.8) were significant independent risk factors for excess blood loss in women with cesarean sections. CONCLUSION: A maternal age of > or = 35 years was an independent risk factor for excess blood loss irrespective of the mode of delivery, even after adjusting for age-related complications such as leiomyoma, placenta previa, and low lying placenta.     

Leiomyoma of the female urethra]

Extrauterine leiomyomas of the female urogenital tract are seldomly described in the present literature. We report on a 47-year-old patient with a large suburethral leiomyoma, which was misinterpreted as a vaginal descensus. Aspects of diagnosis and treatment are discussed.     

Leiomyoma of the female urethra. A case report

A huge vaginal mass arose from the urethra, causing obstruction and urinary retention. Preoperative biopsy revealed a benign leiomyoma. Vaginal excision of the mass was performed without complications.     

Cotyledonoid dissecting leiomyoma of the uterus associated with endosalpingiosis

Cotyledonoid dissecting leiomyoma (CDL) may create a diagnostic challenge. A 47-year-old woman underwent laparotomy for a large pelvic mass associated to vaginal bleeding. During operation, a bulky deep red mass protruding from the uterus and projecting into the pelvic cavity was discovered. Allowing to sarcoma- like appearance, a total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed with removal of the pelvic tumor extension. The diagnosis of cotyledonoid dissecting leiomyoma of the uterus associated with endosalpingiosis was performed. To the best of our knowledge, this association has never been encountered in the English literature.