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SUBURETHRAL LEIOMYOMA.

Leiomyomas of the anterior vaginal wall or suburethral localization are very rare and sporadic cases are described in the literature. They are related mostly to clinical symptoms that include dyspareunia, pelvic pain and urinary symptoms, and dysuria with or without stress incontinence (1,2). Suburethral localization is atypical because leiomyomas appear exclusively in the myometrium, urinary bladder, urethra and renal pelvis (3).

In august 2012, a 46-year-old woman (gravida 3, para 3) was admitted to Clinical Department of Obstetrics and Gynecology, Sveti Duh University Hospital, in Zagreb, Croatia, with dyspareunia and tumor formation in the anterior vaginal wall, with neat gynecologic and personal history, intrauterine device (IUD) applied for the last five years, and normal Pap cytologic smears. In the past three years, had felt tumorous formation in the anterior vaginal wall that had grown twofold, accompanied by dyspareunia but without incontinence.

A tumor of the intact vaginal anterior wall in median line, about 5 cm from the outer mouth of the urethra, solid, sharply delimited, immobile and painful was found on palpation. Transvaginal ultrasound (US) revealed a suburethral, sharply delimited, solid tumor of 45x38x25 mm, with peripheral vascularization without communication to the urethra, uterus and ovaries, normal morphometry with IUD applied, as confirmed by multi-slice computed tomography (MSCT) of the pelvis and abdomen; oncomarkers were normal. Considering the finding, anterior colpotomy, tumor enucleation and colporrhaphy were performed. The surgery and postoperative course were normal. Histopathologic and immunohistochemical findings pointed to leiomyoma (vimentin, actin and desmin positive, staining and Mallory): bundles of spindle cells separated by scarce binder, with rare mitoses (1/10 HPF) without polymorphism, necrosis and infiltrations.

Theodoridis et al (3) describe a 3.5 cm subvesical solid tumor of the anterior vaginal wall, compressing the bladder wall and associated with dyspareunia; they performed tumor enucleation verifying benign leiomyoma. Recurrence is extremely rare, but one case has been described in the literature so far (4). Although very rare, tumors of the urethrovaginal/vesicovaginal spaces are benign and surgical enucleation after diagnostic imaging (US, MSCT, magnetic resonance imaging) is final treatment with good prognosis and absence of clinical symptoms of dyspareunia, chronic pelvic pain, dysuria and incontinence.

References

(1.) Adduci J. Leiomyoma of the anterior vaginal wall in a suburethral location causing stress incontinence: report of a case. J Urol. 1965;93:255-7.

(2.) Shaw CT. Vaginal leiomyoma as a cause of pelvic pain and cystitis cystica. J Am Osteopath Assoc. 1989;89(10):1330-1.

(3.) Theodoridis TD, Zepiridis L, Chatzigeorgiou KN, Papanicolaou A, Bontis JN. Vaginal wall fibroid. Arch Gynecol Obstet. 2008;278:281-2. doi: 10.1007/s00404-008-0576-9

(4.) Dhaliwal LK, Das I, Gopalan S. Recurrent leiomyoma of the vagina. Int J Gynaecol Obstet. 1992;37(4):281-4.

Dubravko Habek and Ingrid Marton

Clinical Department of Obstetrics and Gynecology, Sveti Duh University Hospital and Croatian Catholic University, Zagreb, Croatia

Correspondence to: Prof. Dubravko Habek, MD, PhD, Clinical Department of Obstetrics and Gynecology, Sveti Duh University Hospital, Sveti Duh 64, Croatian Catholic University, Ilica 242, HR-10000 Zagreb, Croatia

E-mail: dubravko.habek@os.t-com.hr

Received November 9, 2016, accepted April 18, 2017
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Author:Habek, Dubravko; Marton, Ingrid
Publication:Acta Clinica Croatica
Article Type:Letter to the editor
Date:Jun 1, 2017
Words:513
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