Polypoid cystic adenomyosis of the uterus: report of a case.

A case of focal adenomyosis of the uterus with unusual gross features is presented. The patient, a 43-year-old woman, had experienced abnormal vaginal bleeding for 8 years. Hysteroscopy revealed a polypoid mass compatible with a submucosal leiomyoma, and a hysterectomy was performed. The uterus showed a 7 x 5 x 3-cm firm polypoid mass attached to the anterior wall that occupied most of the uterine cavity and protruded through the cervical os. It contained a large, central, cystic cavity filled with bloody fluid that communicated with the endometrial cavity through a fistula-like tract. Both the surface of the mass and the inside of the cystic cavity were covered by endometrial mucosa, and there were endometrial islands in the intervening wall. The differential diagnosis of this unique form of adenomyosis included polypoid submucosal leiomyoma with invagination of endometrium, endometrial polyp, submucosal leiomyoma with invagination of endometrium, endometrial polyp, and uterine diverticulum.     

Giant prolapsed submucous leiomyoma: a surgical challenge for gynecologists

We present a case of a 45-year-old woman who presented with irregular vaginal bleeding and menorrhagia for two months, with an episode of massive bleeding initiating 24 hours before with hemodynamic shock. Vaginal inspection showed a soft, rounded, friable mass in vaginal introitus. After hospitalization, blood transfusion and hydration, she was submitted to vaginal myomectomy with the withdrawal of a 12-cm white, solid, huge, pedunculated, leiomyoma; however, hysterectomy was performed due to persistent uterine bleeding. The postoperation period had no complications. Macroscopy showed a retraction of the myoma pedicle. Gynecologists should prioritize clamping of a pedicle before surgery, reducing its size if the tumor is large.     

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.     

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.     

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.     

Diagnosis of a tumor with an unusual presentation in the pelvis

A 47-year-old multiparous woman was first seen with signs and symptoms of sudden, copious vaginal bleeding. The pelvic examination revealed a classic-appearing aborting leiomyoma. Subsequent operation and histologic examination, however, revealed a rare pelvic tumor. The diagnostic evidence and management are outlined.     

Uterine inversion due to a leiomyoma on postpartum day 41: a case report

Uterine leiomyomas are common tumors in women of reproductive age and are frequently detected during pregnancy. The major complications during pregnancy include abortion, preterm delivery, abruptio placentae, intrauterine growth retardation, dystocia, and postpartum hemorrhage. Little attention is given to uterine leiomyomas postpartum compared to leiomyomas prior to childbirth. In the present case, a 27-year-old woman, gravida 1 para 1, presented with massive vaginal bleeding, urinary retention and lower abdominal pain on postpartum day 41. She was diagnosed with uterine inversion due to leiomyoma. After a vaginal myomectomy, the uterus was re-placed with a combined vaginal and abdominal approach. Because of timely medical intervention, the patient managed to overcome the crisis and her reproductive organs were successfully preserved.     

A giant uterine leiomyoma simulating an ovarian mass in a 16-year-old girl: a case report and review of the literature

Uterine leiomyomas are extremely rare neoplasms in the pediatric and adolescent population. We report a case of a giant uterine leiomyoma measuring 30 cm in the largest diameter in a 16-year-old girl. To our knowledge this is the largest leiomyoma reported thus far in women under the age of 20 years. The patient was admitted to our hospital for the investigation of menstrual disorders, vaginal bleeding and progressive abdominal enlargement. Preoperative diagnosis was ovarian malignancy. Myomectomy was performed. Histopathologic study of the tumor showed an otherwise typical leiomyoma, both grossly and microscopically, with extensive hydropic and myxomatous degeneration and areas of prominent vessels, suggesting an angiomatous neoplasm. Leiomyomas in teenagers often exhibit histological features favoring the diagnosis of malignancy, and should be evaluated with extreme caution. The management of leiomyomas in these young patients should be conservative for the preservation of fertility.     

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.     

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.     

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.     

A case of invasive squamous cell carcinoma on the surface of pedunculated cervical leiomyoma presenting an exophytic cervical cancer

BACKGROUND: Cervical cancer on the mucosal surface of a pedunculated cervical leiomyoma has not been reported. CASE: A 54-year-old woman who had a bulky protruding cervical tumor with a history of a vaginal bleeding was diagnosed as having squamous cell cancer of the cervix. She received a total of 45 Gy (1.8 Gy daily using 15MV photons) external pelvic irradiation. However, on the follow-up MRI, the mass showed no response. The pedunculated exophytic mass was excised and the pathologic examination showed a leiomyoma covered by cervical stroma and squamous cell carcinoma. She then received additional intracavitary brachytherapy. CONCLUSION: This is the first case reported in the literature of squamous cell carcinoma on the surface of peduculated cervical leiomyoma that presented as an exophytic cervical tumor.     

Primary malignant melanoma of the vagina: a case report

Primary malignant melanoma of the vagina is a very rare, but very aggressive tumor. We describe a case of primary vaginal melanoma and review the literature. The patient, a 73-year-old, gravida 2, para 2 postmenopausal Greek woman, presented with abnormal vaginal bleeding for 30 days. On vaginal examination there was a 5.5 x 5 x 2 cm raised, ulcerated and irregular lesion on the posterior vaginal wall. Pathology examination of the entire specimen demonstrated a nodular vaginal melanoma. The histologic diagnosis was confirmed by positive immunostaining. The patient began postoperative immunotherapy with interferon-a2b. She died 25 months later because of cerebral metastases. In conclusion, the prognosis of vaginal melanoma is very poor, despite the treatment modality, because most cases are diagnosed at a late stage.     

Clinical considerations and sonographic findings of a large nonpedunculated primary cervical leiomyoma complicated by heavy vaginal haemorrhage: a case report and review of the literature

Leiomyomas of the uterine cervix are uncommon. Cervical leiomyomas in non-pregnant women rarely are of clinical significance and their complications include pressure effects on the bladder or urethra, degenerative phenomema and menorrhagia. We present a case of 46-year-old female, gravida 2, para 1 who was presented in the gynaecological emergency room with the chief complaint of profound vaginal bleeding over the previous three weeks with recent passage of clots. Pregnancy test was negative. She suffered from profound orthostatic hypotension and tachycardia. On examination, her abdomen was soft, non-tender, and without rebound, guarding or palpable masses. Bimanual examination was notable for the presence of a large firm mass fixed to the uterine cervix. The cervix was 8 cm dilated and the body of the uterus was felt separate from the mass. The sonographic findings were consistent with a large cervical leiomyoma. Subtotal hysterectomy with salpingo-oophorectomy was performed and the patient's postoperative course was uneventful. In conclusion, in the present case the cause of the heavy vaginal bleeding was a primary cervical fibroid as the uterus attempted to abort it.     

Successful term pregnancy following MR-guided focused ultrasound treatment of uterine leiomyoma.

OBJECTIVE: Term vaginal delivery after magnetic resonance-guided focused ultrasound therapy (MRgFU) for symptomatic uterine leiomyoma. STUDY DESIGN: A 38-year-old nulligravida underwent MRgFU treatment per study protocol for a solitary 9 x 10 x 10 cm uterine myoma and conceived 18 months following the procedure. She was counseled on the unknown implications of MRgFU during subsequent pregnancy. Myoma size increased significantly during gestation. At 39 weeks, she underwent indicated labor induction with vacuum-assisted vaginal delivery of a healthy male infant. CONCLUSION: In one pregnancy following MRgFU, there were no associated antepartum or intrapartum obstetrical complications.     

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.     

Huge localized vaginal neurofibromatosis: an unusual cause of postmenopausal bleeding

A 55-year-old lady, menopausal for 8 years, presented with vaginal swelling for the preceding 6 months and with post menopausal bleeding (two bouts). Examination revealed a vaginal mass of 7 x 5 cm which was ultrasonically diagnosed as vaginal fibroid. The vaginal mass was excised and confirmed to be a vaginal neurofibroma on histopathology.     

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.     

The management of an unusually sited isthmicocervical leiomyoma and a huge prolapsed pedunculated submucous leiomyoma

We present two case studies: an unusually sited isthmicocervical leiomyoma and a huge prolapsed pedunculated submucous leiomyoma of the uterus. Case 1 was a 25-year-old virginal woman with a diagnosis of cervical leiomyoma with symptoms of anemia and menorrhagia. Magnetic resonance imaging revealed a mass impinging on the bladder and rectum. Myomectomy was the selected operation because of the patients age and her desire to preserve fertility, even though the tumors size and location increased the risk of operative blood loss and would make the surgical procedure difficult to perform. The pathological specimen was benign. Case 2 was a 43-year-old patient with a chief complaint of difficulty in voiding plus severe vaginal bleeding. The gynecological examination revealed a necrotic mass that filled the vagina completely and stretched its walls. The sonographic findings were consistent with a pedunculated submucous leiomyoma. Total abdominal hysterectomy and bilateral salpingoophorectomy were performed. The histopathological evaluation was benign leiomyoma of the uterus. Cervical and pedunculated submucous leiomyomas are uncommon and represent a technicosurgical difficulty due to location and huge size. However, in order to regress the complications and improve the patients quality of life regarding desire to preserve fertility, conservative surgical regimens should be chosen.     

子宫肌瘤患者的子宫内膜病理特征分析

目的:探讨子宫肌瘤患者的子宫内膜病理特征及相关因素。方法:选取2002~2004年479例子宫肌瘤患者,分析其子宫内膜病理特征。结果:479例患者中有97例表现阴道不规则流血,单发肌瘤220例,多发肌瘤259例,子宫肌瘤变性70例,67例子宫肌瘤为富于细胞型平滑肌瘤。109例患者发生子宫内膜病变,包括子宫内膜息肉42例(8.77%)、子宫内膜单纯增生41例(8.56%)、复杂增生12例(2.51%)、非典型增生3例(0.63%)、子宫内膜癌11例(2.30%)。结论:子宫肌瘤可同时合并子宫内膜病变及子宫内膜癌,子宫肌瘤单发或多发、子宫肌瘤变性等情况与子宫内膜病变无关。不规则阴道流血、绝经与子宫内膜病变及子宫内膜癌的发生有关。