Abstract

Vaginal Leiomyoma is a rare tumour with a variable presentation. Vaginal Leiomyoma can also present as a imitator of prolapse. Shaw reported a case of Leiomyoma that became clinically apparent at postpartum period. A surgical approach through the anterior vaginal wall avoids urethral injury; an enucleation is curative.

Introduction

Leiomyoma is the benign mesenchymal tumour of the vagina. The patients are adults and any region of the vagina can be affected.^1,2 The utility of sonography in the evaluation of the internal anatomy of the female pelvis is well established, but little has been reported on the characterization of vaginal masses. Prolapsing fibromyomas can be diagnosed via the contiguous uterine component. The tumours are often rare and asymptomatic but can cause dyspareunia, urinary urgency and urge incontinence.^3,4

Case Report

We present a case of vaginal Leiomyoma of a woman age 32 years married with swelling on the left vaginal wall since ^1-2 years complaining of dull aching pain. Clinical examination reveal hard nodular peanut size swelling, movable measuring 3 x 2 x 2 cms arising from anterior vaginal wall. Pathologically tumour mass was well circumscribed and had the typical microscopic feature of benign Leiomyoma as found elsewhere.

Discussion

Vaginal Leiomyoma is a rare tumour with a variable clinical presentation and broad differential diagnosis that can lead to pre- operative misdiagnosis. Leiomyoma developing de novo from elements of vagina is a rare phenomenon.^5,6 Tumours arising from the upper part of vagina is mistaken for a cervical fibroid. Vaginal Leiomyoma can also present as a imitator of prolapse. Leiomyosarcoma and Leiomyoma of the vagina has been reported where the treatment of choice is chemotherapy and enucleation of Leiomyoma because of the possibility of undergoing malignant change.7

Fig. 1 : H and E stained section 10x - leiomyoma.

The solid tumours arising from vagina include papilloma haemangioma rarely Leiomyoma since the vaginal mucosa is a non keratinizing squamous epithelium. There is numerous lymphatics and venous pleuxis. The submucosa is surrounded by tunica muscularis vaginae, overlaid by longitudinal layer of loose connective tissue cover in turn. Shaw reported a case of Leiomyoma that became clinically apparent at postpartum period.8-10 Correct pre-operative diagnosis of these lesions can avert the therapeutic error. Diagnostic clues include a solid noncystic mass that does not communicate with the urethra, is circumscribed and has essentially normal overlying mucosa. A surgical approach through the anterior vaginal wall avoids urethral injury and enucleation is curative.¹¹

Finally one should consider and advice for ultrasonography, MRI, positive pressure urethrography and urethrocystoscopy in the evaluation of an anterior wall vaginal mass. If surgical procedure results in skeletanization of the urethral and bladder support, a colporrhaphy/pubourethral ligament plication is advised.⁴

References

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*Associate Professor, **Resident, Department of Ophthalmology, T.N.M.C and B.Y.L. Nair Hospital, Mumbai - 400 008.