Vaginal leiomyoma, post hysterectomy, mimicking vault prolapse: case report

Abstract

Leiomyomas are common benign smooth muscle tumours of the uterus. Leiomyoma of the vagina are very rare with only about 300 reported cases. Correct diagnosis and differentiation from urethral lesions are important but is usually difficult on clinical examination alone. A 40-year P3L3, with a previous history of abdominal hysterectomy 5 years back, for multiple fibroids presented with complaints of a mass descending per-vagina since the last 2 years. Since the last 6 months she had dyspareunia, dysuria and perineal discomfort. On external appearance the mass looked like a vault prolapse. However, on vaginal examination, it appeared as a single well circumscribed mass arising from the anterior vaginal wall and the vault. Transvaginal sonography showed a hypoechoic mass arising from the anterior vaginal wall of dimension 50×54×63 mm pressing on the urethra. Contrast CT revealed a rounded homogeneous well-defined soft tissue density mass lesion measuring approximately 63×52 mm in the region of the vaginal vault interposed between the bladder base and the rectum. Bilateral ovaries and adnexa appeared normal. Surgical excision of the tumour through the vagina was done. Histopathology confirmed leiomyoma.  The diagnosis of vaginal leiomyoma is based on careful examination and preoperative imaging both by ultrasonography and a CT scan/MRI for ascertaining its location, extent, its relationship to adjacent structures and characterization before attempting surgical excision. The correct clinical diagnosis of a vaginal fibroid is frequently overlooked in favour of much more common urethral diverticulum.