Laparoscopic resection of a vaginal leiomyoma that presented with significant genital bleeding

Abstract

Gynecological leiomyomas most frequently occur in the uterus and rarely in the vaginal wall. We report a case of vaginal leiomyoma in a 35-year-old woman who presented with significant genital bleeding as a rare presentation of this tumor. Physical examination showed a bleeding mass (10 mm) at the posterior vaginal vault. Gauze compression was applied for 3 days to control bleeding. Transvaginal ultrasonography and contrast-enhanced magnetic resonance imaging revealed a tumor protruding into the pouch of Douglas, which led to a high index of clinical suspicion for a mesenchymal tumor or Schnitzler metastasis from a gastrointestinal malignant tumor. Although a vaginal biopsy could not definitively diagnose the lesion, a malignant tumor could not be excluded, and we performed laparoscopic total tumor resection.Histopathological examination revealed a leiomyoma. She has shown no recurrence over 9 months since the surgery.Massive bleeding secondary to a vaginal leiomyoma as observed in this patient is extremely rare, and preoperative diagnosis is challenging. Laparoscopic resection with vaginal assistance may be useful in patients in whom the vaginal approach alone is ineffective.