Vaginal leiomyoma: medical imaging and diagnosis in a resource low tertiary hospital: case report

Abstract

Background: In the literature under review there are about 300 reported cases of vaginal leiomyomas with none from Cameroon. We report a case of vaginal leiomyoma and highlight the diagnostic challenges faced at the Douala Referral Hospital (DRH), Cameroon. Case presentation: A 36-year-old G3P3002 sexually active Cameroonian married woman reported dysuria, dyspareunia, cessation of sexual intercourse and offensive smelling vaginal discharge for 6 months and a 3-year history of a vaginal tumour; she was misdiagnosed despite ultrasonography and magnetic resonance imaging (MRI) but was corrected by an experienced radiologist. She underwent first look laparoscopy, surgical excision of the tumour through the vagina and histopathology analysis that confirmed leiomyoma. Conclusion: Posterior location of vaginal leiomyomas found in this case is a rare occurrence. The diagnosis is based on careful examination and preoperative imaging (ultrasonography and MRI). However, the definitive diagnosis is usually made intra-operatively. We combined laparoscopic exploration of the internal genital organs and per vaginal excision of the vaginal leiomyoma. Thus, we recommend frozen section biopsy to exclude leiomyosarcoma.

A Paraurethral Vaginal Mass in Rural Setting: A Case Report

“…Egbe, et al suggested considering the assessment of lactate dehydrogenase (LDH) isoenzyme to differentiate the leiomyosarcoma. 2,13 However, MRI and LDH assessment were limitations in our context. Surgical excision is the treatment of choice.…”

Primary vaginal leiomyoma in a hysterectomised woman presenting with urgency

“…The tumor may be palpated as solid or cystic which may be misleading as in our case. Location at the anterior vaginal wall may result in urgency, stres urinary incontinance, disuria, disparouneia and a sense of fullness (8). In this case the mass made the patient complain about urgency in micturition and a mass filling the vagina.…”

Leiomyoma of levator ani muscle

“…2,5 The diagnosis can be made from the pelvic examination or with some image testing such as ultrasound, urethrocystography, urethrocystoscopy, tomography or magnetic resonance. 6 Ultrasound, tomography and magnetic resonance images resemble those of cervical myoma. They are frequently confused with other vaginal tumors and the correct diagnosis is made with histological examination.…”

“…9 The differential diagnosis includes other vaginal tumors, such as: Gartner, Bartholino or Skene gland cysts, urethral diverticula, urethrocele, cystocele, rectocele and neurofibromas. 6 Excision and enucleation is the treatment option in all series. Its vaginal excision can cause severe bleeding, especially if the base of the tumor cannot be reached in its entirety or if it is located in the upper third of the vagina.…”