|Year : 2015 | Volume
| Issue : 2 | Page : 135-137
Huge prolapsed cervical myoma mimicking cystocele
Kouach Jaouad1, Benabdejlil Youssef2, Raiteb Hanane2, Moussaoui Driss3, Dehayni Mohamed3
1 Moroccan Medical and Surgical Hospital, Zaatari Camp, Jordan; Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
2 Department of Gynecology Obstetric, Military Training Hospital Med V, Rabat, Morocco
3 Department of Gynecology Obstetric, Military Training Hospital Med V; Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
|Date of Web Publication||16-Jun-2015|
U3, Avenue Sanaoubar, Secteur 19, Hay Riad, Rabat, Morocco
Source of Support: None, Conflict of Interest: None
The occurrence of cervical myoma is not common, but they merit special considerations in view of their proximity to important pelvic structures, their propensity to cause complications and the technical difficulty in their removal. Herein, we report the case of a huge prolapsed cervical myoma micking cystocele in a 38-year-old woman having a history of abortive disease.
Keywords: Cervical fibroid, prolapsed leiomyoma, uterine inversion
|How to cite this article:|
Jaouad K, Youssef B, Hanane R, Driss M, Mohamed D. Huge prolapsed cervical myoma mimicking cystocele. Saudi J Health Sci 2015;4:135-7
| Introduction|| |
Uterine fibroids are the most common tumours of uterus which develop in 20-40% of reproductive age women, but cervical leiomyomas are less than 5% of all leiomyomas.  Pedunculated uterine myomas or submucosal cervical myomas may protrude through the cervical canal and into the vagina and may become necrotic and occasionally infected due to inadequate blood supply. , We present the case of a huge prolapsed cervical myoma simulating cystocele and causing uterine inversion in a 38-year-old woman having a history of abortive disease.
| Case report|| |
A 38-year-old female, Syrian, refugee in Zaatari camp in Jordan, Gravida 14, Para 0, presented to the gynaecology unit of the Moroccan medical-chirurgical hospital for Syrian refugees, with complaints of chronic pelvic pain and abortive disease. She had no medical and family history. Her menstrual cycles were regular and she never used contraception. All her pregnancies resulted in a late spontaneous abortion between 17 and 22 week of gestation. Her last pregnancy was 6 years ago. The patient was never explored for her abortive disease. The patient complained that she noticed something appeared to come down her vagina for the last year associated with chronic pelvic pain, dysuria and chronic constipation. Pelvic examination showed a gaping vulva revealing a reddish mass evoking first cystocele. The introduction of the speculum was impossible. The mass was occupying the entire vaginal cavity. Vaginal touch allowed to bypass the mass, whose consistency was firm, without reaching the upper pole or cervix. Vaginal touch combined with abdominal palpation could not separate the mass from the uterus. An ultrasonography was performed which showed a 20 × 17 cm hypoechoic mass in the upper part of vagina [Figure 1] and a possibility of pedunculated cervical fibroid was made. There was no other abnormality on ultrasonography. The tumour was surgically removed by vaginal route [Figure 2] and [Figure 3]. Histopathological examination of the specimen confirmed the diagnosis of a submucous leiomyoma arising from the cervix of the uterus [Figure 4]. There were no complications in the postoperative period and the patient was able to be discharged on the third postoperative day. The patient was symptom-free at 6-month follow-up.
| Discussion|| |
Cervical leiomyomas are extremely rare and the incidence is reported at about 0.6% in total hysterectomy specimens.  Cervical leiomyomas can be categorized as extracervical type (subserosallocation) and intracervical type (occur within the cervix). The complications of cervical leiomyomas include pressure effects on the bladder or urethra, degenerative phenomena, intermenstrual bleeding, pain (pelvic cramping), prolapse with infection and torsion.  The management of cervical myoma is a real challenge to the gynaecologist. Besides the excessive menstruation, severe anaemia and propensity to infection, long standing pressure on neighboring structures like ureters causing hydronephrosis and acute renal failure have been reported with this myoma. Cervical leiomyoma may elongate, prolapse out the uterine cavity and present with emergency like retention of urine. Uterine artery embolisation , and laparoscopic-assisted uterine depletion of the myomas  may precipitate the degeneration and prolapse of exiting cervical myoma. Route and type of surgery should be planned in advanced especially in nulliparous woman. Ben-Baruch et al.,  have studied the immediate and late outcomes and recommended vaginal myomectomy as the initial treatment of choice for prolapsed pedunculated submucous myoma, except in those cases in which other indications necessitate an abdominal approach. In recent times, hysteroscopic myomectomy can be preferred if the myoma is small and the pedicle is accessible. Regarding the need for hysterectomy in patients who have completed the family and not keen on preserving the uterus, the choice of route was analyzed by Benassi et al., (2002).  It was found that vaginal route is preferable to abdominal route as the operating- time, cost, postoperative fever, and need for analgesia are reported to be less without any significant difference in blood loss or other complications. In our case, a combined approach was used considering the confusion in diagnosis, large mass felt through the abdomen and inaccessibility of the pedicle of cervical myoma by a solitary vaginal route.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]