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Wagey FMM, Lengkong R, Wagey FW, Tendean HMM, Wantania JJE, Suparman E, Laihad BJ, Mongan SP, Mamengko LM, Kaeng JJ, Sondakh MMJ, Sutandar Y, Theresa MG. Vaginal Myomectomy and Total Vaginal Hysterectomy on Large Prolapsed Cervical Myoma: A Case Report. J Med Cases 2021; 12:288-290. [PMID: 34434474 PMCID: PMC8383691 DOI: 10.14740/jmc3698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/19/2021] [Indexed: 11/11/2022] Open
Abstract
Cervical myomas are benign tumors originating from cervical muscle tissue with a very rare incidence of only about 8% of all myomas. The surgical approach depends on the position of cervical myoma. This case report discusses a 44-year-old woman who complained of a lump discharge from her birth canal 6 months ago, and currently discharging from her vagina. We performed vaginal myomectomy, and the cervical myoma measuring 8 × 8 × 6 cm with solid consistency was removed. We continued with total vaginal hysterectomy. Post-operative recovery was progressing well. The histopathology report was consistent with leiomyoma. Large prolapsed cervical myoma can be disturbing and discomforting for many patients. It is relatively rare and can be successfully removed vaginally with minimal morbidity.
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Affiliation(s)
- Frank M M Wagey
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
| | - Rudy Lengkong
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
| | - Freddy W Wagey
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
| | - Hermie M M Tendean
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
| | - John J E Wantania
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
| | - Erna Suparman
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
| | - Bismarck J Laihad
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
| | - Suzanna P Mongan
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
| | - Linda M Mamengko
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
| | - Juneke J Kaeng
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
| | - M M Joice Sondakh
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
| | - Yosep Sutandar
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
| | - Maria Gladys Theresa
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou General Hospital Manado, Manado, Indonesia
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Ferrari F, Forte S, Valenti G, Ardighieri L, Barra F, Esposito V, Sartori E, Odicino F. Current Treatment Options for Cervical Leiomyomas: A Systematic Review of Literature. ACTA ACUST UNITED AC 2021; 57:medicina57020092. [PMID: 33494297 PMCID: PMC7911900 DOI: 10.3390/medicina57020092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: Cervical leiomyomas are a rare benign disease. Although they are mainly treated surgically, currently, there is not a standardized treatment for cervical leiomyomas. This study aims to summarize current literature evidence about treatment options for cervical leiomyomas. Materials and methods: A systematic research of the literature was conducted in Scopus, PubMed/MEDLINE, ScienceDirect, and the Cochrane Library, including observational prospective and retrospective studies, case series and case reports. We collected data regarding studies related to treatment options for cervical leiomyomas, evaluating the following aspects: study design, population, treatment type, rate of surgical complications, and fertility outcome. Results: According to literature research, 38 articles were included. Among 214 patients, the weighted average age was 39.4 years-old; 23 patients were pregnant. Most of the leiomyomas (78%) were extracervical; in 22% of cases (29 patients) were intracervical; 188 patients (88%) received surgical treatment, 6 (3%) received exclusive conservative management and 21 (10%) underwent interventional radiology treatment. One hundred twenty-seven patients (67.5%) underwent myomectomy, while 54 (28.7%) and 7 (3.7%) hysterectomy and trachelectomy, respectively. Cervical myomectomy was performed by open surgery in 21 out of 127 cases (16.5%), while in 92 (72.4%) and 6 (4.7%) patients the surgical approach was performed by traditional and robot-assisted laparoscopy, respectively. The total rate of surgical complications was 5.6%. Conclusion: Surgery is the primary therapeutic option for cervical leiomyomas with a low rate of surgical complications. Interventional radiology techniques have reported promising but still limited results.
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Affiliation(s)
- Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili of Brescia, 25123 Brescia, Italy;
| | - Sara Forte
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (S.F.); (E.S.); (F.O.)
| | - Gaetano Valenti
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Gynecology, University of Catania, 95123 Catania, Italy;
| | - Laura Ardighieri
- Department of Pathology, Spedali Civili of Brescia, 25123 Brescia, Italy;
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, 16100 Genova, Italy
- Correspondence: ; Tel.: +39-334-943-7959
| | - Valentina Esposito
- Department of Gynecology and Obstetrics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Enrico Sartori
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (S.F.); (E.S.); (F.O.)
| | - Franco Odicino
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (S.F.); (E.S.); (F.O.)
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González González V, Herráez Moreta A, Mayoral Triana A, Riolobos Sierra L, Cristóbal García I, Izquierdo Méndez N. Prolapsed cervical myoma during pregnancy. Eur J Obstet Gynecol Reprod Biol 2020; 252:150-154. [PMID: 32619878 DOI: 10.1016/j.ejogrb.2020.06.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/01/2022]
Abstract
Prolapsed submucosal myomas during pregnancy are uncommon, and few cases of patients undergoing vaginal myomectomy during pregnancy have been reported. In our center, a 13 weeks pregnant patient with prolapsed cervical myoma was diagnosed. Because of intermittent vaginal bleeding, surgery was scheduled at 13 weeks and 5 days of pregnancy. A vaginal myomectomy was performed. The postoperative course was uneventful. Cervical leiomyomas and prolapsed submucosal leiomyomas in pregnancy are rare clinical entities, and the literature is comprised of only case reports. We reviewed the current literature in regard to prolapsed cervical leiomyomas in pregnancy and provide an updated vision of the literature.
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Affiliation(s)
| | | | | | - Luana Riolobos Sierra
- Gynecology and Obstetrics Department, Hospital Clínico, Universitario San Carlos, Spain
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A Case Report of Overcoming an Obstructive, Pedunculated Cervical Fibroid at the Time of Uterine Evacuation. Case Rep Obstet Gynecol 2019; 2019:2651680. [PMID: 31281693 PMCID: PMC6590615 DOI: 10.1155/2019/2651680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/20/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Fibroids, which can impact pregnancies at later gestations, such as obstructing delivery, may also affect the pregnancy termination process. CASE We present the case of a 28-year-old G1 at 18 weeks who consented for a genetic pregnancy termination via dilation and evacuation. During the typical preparatory procedure with laminaria, it was noted that a 5-6cm cervical fibroid prolapsed into the vagina obstructing access to the uterine cavity. Through osmotic dilation followed by cervical Foley catheter ripening, a planned myomectomy was possible with minimal blood loss prior to uterine evacuation. CONCLUSION Through appropriate counselling, planning, and effective cervical dilatation, a planned myomectomy for prolapsing fibroids at the time of termination of pregnancy is possible. This can prevent unnecessary hysterotomy and avoid need for subsequent cesarean section.
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Lipoleiomyoma of the uterine cervix: An unusual variant of uterine leiomyoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tian J, Hu W. Cervical leiomyomas in pregnancy: report of 17 cases. Aust N Z J Obstet Gynaecol 2012; 52:258-61. [PMID: 22360538 DOI: 10.1111/j.1479-828x.2012.01414.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 01/08/2012] [Indexed: 11/28/2022]
Abstract
AIM To analyse the management strategies and delivery outcomes of women with cervical leiomyomas in pregnancy. METHODS We retrospectively analysed the pregnancy outcomes of 17 women with cervical leiomyomas. The outcome measures assessed included the volume of blood loss at delivery, need for blood transfusion, intra- and post-operative complications and length of hospital stay. RESULTS The mean diameter of the leiomyomas was 10.4 ± 7.2 cm, with a range of 3-30 cm. The mean blood loss was 697 ± 394 mL (range of 350-4200 mL). Six women (35.3%) required a blood transfusion. The mean duration of stay in hospital after delivery was 7.9 ± 3.9 days (range 4-20 days). There were three cases of severe haemorrhage or infection post-operation necessitating hysterectomy, and all of the leiomyomas in these cases were more than 20 cm in diameter. There was a positive correlation between the blood loss volume and the size of leiomyomas (correlation coefficient 0.638, P < 0.01). CONCLUSIONS The dimensions of cervical leiomyomas influences post-partum blood loss. Large cervical leiomyomas appear associated with adverse outcomes. When the leiomyomas are relatively small, an experienced practitioner could consider myomectomy during a caesarean delivery.
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Affiliation(s)
- Jishun Tian
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Affiliation(s)
- A M Khan
- Women’s Health, Jenner Building, Whittington Hospital, Magdala Avenue, London N19 5NF, UK.
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