Coexistence of a Tubal Ectopic Pregnancy and Tubal Leiomyoma

Abstract

A 28-year-old nulligravida woman with regular menstruation previously presented with 2 months of amenorrhea, right lower abdominal pain, and vaginal bleeding for 1 day. On clinical examination, the patient was hemodynamically stable. Abdominal examination revealed right iliac fossa tenderness. Speculum examination revealed minimal vaginal bleeding. On vaginal examination, a normal-sized uterus with an adnexal mass in the right fornix was observed. Cervical motion tenderness was present. A urine pregnancy test was positive. The quantitative beta human chorionic gonadotropin was 15 146 IU/mL. A transvaginal ultrasound scan was performed, which showed no evidence of an intrauterine pregnancy with an empty uterus filled with fluid. There was a right tubal unruptured ectopic pregnancy with a gestational sac 34 mm in size; a yolk sac was noted. The crown rump length was 24 mm with a fetal heart rate of 164 beats/min. The estimated gestational age was 8 weeks 4 days based on the ultrasound findings. Laparoscopic examination was performed, which revealed a 5 × 3 cm right fallopian tubal unruptured pregnancy in the ampulla with a 1 × 1 cm right tubal mass in the isthmus (Fig. 1). A right salpingectomy was performed followed by a peritoneal lavage (Fig. 2). The 1 × 1 cm mass was whitish, firm, and incompressible in nature (Fig. 3). The mass was extruded in the pelvis during the salpingectomy. Both the ovaries and the left tube were normal. The right fallopian tube and the mass were sent for histopathological examination, which confirmed the presence of a gestational sac and a 1 × 1 cm leiomyoma in the tube along with the ectopic pregnancy. The coexistence of a tubal leiomyoma and a tubal ectopic pregnancy is extremely rare [1]. Tubal leiomyomas may predispose to tubal implantation of a conceptus because of The authors declare that they have no conflict of interest.

Leiomyoma of the fallopian tube found during laparoscopic myomectomy: A case report and review of the literature

“…Leiomyoma of the fallopian tube are mostly unilateral, small and asymptomatic, and most cases are discovered incidentally during diagnostic laparoscopy or other operations. Some patients may seek medical attention due to the huge size of tubal leiomyoma or abdominal pain caused by torsion or degenerative changes of leiomyoma, or due to the coexistence of tubal ectopic pregnancy and tubal leiomyoma (2,9,12). The pathogenesis of ectopic pregnancy may be that tubal leiomyoma compresses the lumen of the fallopian tube or tubal leiomyoma lead to alteration in the ciliary motion in the tube so that the fertilized egg implants in the tube.…”