An unusual cause of postmenopausal bleeding-a case report of extrauterine leiomyoma.
Citation: BJOG: An International Journal of Obstetrics and Gynaecology, June 2013, vol./is. 120/(575-576), 1470-0328 (June 2013)
Author(s): Nausheen S.
Abstract: Postmenopausal bleeding (PMB) in women can be due to various benign and malignant causes. Uterine leiomyomas can cause PMB in association with endometrial hyperplasia, cancer or rarely sarcomatous transformation. Here is an unusual case of extrauterine leiomyoma which caused the PMB. Case An anxious 79-year-old Caucasian lady presented with unprovoked postmenopausal bleeding of 3 weeks duration with a lump per vaginum which pops out of the vagina and requiring her to push it back. She underwent an abdominal hysterectomy for fibroids in her 40 s. She had no problems with bowel or bladder. She had not been on HRT. On examination she had a normal vulva with a polypoidal swelling 2.5 x 3 cm in size in the lower third of vagina on the right side. The mucosa was vascular with smooth surface and the mass was firm in consistency, non-tender and was not fixed to deeper structures. She had a normal vault. There were no other pelvic or vaginal masses. She had an emergency attendance with another episode of heavy PMB. She had MRI which showed an oval well defined mass representing a benign leiomyoma arising in the lower vagina of size 2.6 9 2.2 cm, showed homogenous low signal on the T2 images with no evidence of infiltration into adjacent structures and no abnormality seen within the remainder of the vagina. Due to her symptoms, excision was done and histology confirmed it as a benign leiomyoma.
Discussion Extrauterine leiomyoma seen in our patient is a rare, benign tumor which may arise from smooth muscle cells, is reported in the vulva, ovaries, broad ligament, urethra and urinary bladder. In addition, unusual growth patterns may be seen, including benign metastasising leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal growth. However, some extrauterine leiomyomas may mimic malignancies causing serious diagnostic dilemma. The most useful modalities for detecting extrauterine leiomyomas are ultrasonography, computed tomography, and magnetic resonance (MR) imaging. Our patient presented with vaginal leiomyoma which caused her recurrent symptoms of PMB due to its growth and surface vasculature, though she had not been on the HRT. However as she had unusual bleeding, MRI excluded any other pathology; hence this case emphasises the clinicians to be aware of this rare tumor.
Publication Type: Journal: Conference Abstract