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Year : 2015  |  Volume : 4  |  Issue : 2  |  Page : 135-137

Huge prolapsed cervical myoma mimicking cystocele

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 Publication16-Jun-2015

Correspondence Address:
Kouach Jaouad
U3, Avenue Sanaoubar, Secteur 19, Hay Riad, Rabat, Morocco

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2278-0521.157897

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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

How to cite this URL:
Jaouad K, Youssef B, Hanane R, Driss M, Mohamed D. Huge prolapsed cervical myoma mimicking cystocele. Saudi J Health Sci [serial online] 2015 [cited 2021 May 7];4:135-7. Available from: https://www.saudijhealthsci.org/text.asp?2015/4/2/135/157897

  Introduction Top

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. [1] 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. [2],[3] 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 Top

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.
Figure 1: Pelvic ultrasound showing the uterus and the cervical fibroid

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Figure 2: Fibroid landlocked in the vagina

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Figure 3: Pedicle fibroma inserted into the vaginal vault

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Figure 4: Resected specimen

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  Discussion Top

Cervical leiomyomas are extremely rare and the incidence is reported at about 0.6% in total hysterectomy specimens. [4] 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. [5] 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 [6],[7] and laparoscopic-assisted uterine depletion of the myomas [8] 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., [2] 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). [9] 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.

  References Top

Buttram Jr VC, Reiter RC. Uterine leiomyomata: Etiology, symptomatology, and management. Fertil Steril 1981;36:433-45.  Back to cited text no. 1
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. 2
Golan A, Zachalka N, Lurie S, Sagiv 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. 3
Tiltman AJ. Leiomyomas of the uterine cervix: A study of frequency. Int J Gynecol Pathol 1998;17:231-4.  Back to cited text no. 4
Mayadeo NM, Tank PD. Non-puerperal incomplete lateral uterine inversion with submucous leiomyoma: A case report. J Obstet Gynaecol Res 2003;29:243-5.  Back to cited text no. 5
Bhatla N. Tumours of the corpus uteri. International edition. In: Jeffcoate′s Principles of Gynaecology. 6 th ed. London: Arnold Publishers; 2001. p. 470.  Back to cited text no. 6
Pollard RR, Goldberg JM. Prolapsed cervical myoma after uterine artery embolization. A case report. J Reprod Med 2001;46:499-500.  Back to cited text no. 7
Liu WM, Yen YK, Wu YC, Yuan CC, Ng HT. Vaginal expulsion of submucous myomas after laparoscopic-assisted uterine depletion of the myomas. J Am Assoc Gynecol Laparosc 2001;8:267-71.  Back to cited text no. 8
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. 9


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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