The lantern on the dome of St. Paul's sign in cervical fibroid: a rare presentation and successful outcome

Abstract

Uterine fibroids represent the most common benign tumours of the uterus and are typically located in the uterine body. Cervical fibroids are rare, accounting for only 1–2% of cases. We present the case of 24-year-old female, who was p1+0. She presented to our side with complaints of lower abdominal pain, menorrhagia and frequent micturition since past 1 year. Non-tender, firm, immobile abdominal mass equivalent to a 28-week gravid uterus, with smooth surface and regular margins, was detected on examination.” Ultrasound showed bulky uterus with large fibroid compressing bilateral lower ureter leading as bilateral mild hydronephrosis. Computed tomography report showed similar findings, large posterior fibroid with central degenerative changes with bilateral hydroureteronephrosis secondary to extrinsic ureteric compression by the fibroid. Surgical management consisted of total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathological analysis confirmed cervical leiomyoma with marked inflammatory changes. Recovery was uneventful. Giant cervical fibroids require careful preoperative planning and awareness of ureteric and vascular anatomy. When complications occur after conservative surgery, hysterectomy may be the safest option. The “lantern on Saint Paul’s dome” sign aids clinical and radiological diagnosis.