Download PDF
Geburtshilfe Frauenheilkd 2013; 73(7): 724-726
DOI: 10.1055/s-0032-1328724
Case Report
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Vaginal Removal of Very Large Nascent Uterine Myoma – Case Report and Literature Review

Vaginale Entfernung eines extrem großen Uterusmyoms – Fallbericht und Literaturübersicht
M. Terzic
1   Clinical Center of Serbia, Clinic of Obstetrics and Gynecology; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
,
S. Maricic
2   Occupational Health Department, General Health Center “Savski Venac”, Belgrade, Serbia
,
J. Dotlic
3   Clinical Center of Serbia, Clinic of Obstetrics and Gynecology, Belgrade, Serbia
› Author Affiliations
Further Information

Publication History

received 24 February 2013
revised 01 April 2013

accepted 01 May 2013

Publication Date:
29 July 2013 (online)

Also available at
   Permissions and Reprints

Abstract

This report shows that even extremely large nascent uterine myomas can be removed vaginally. A 25-year-old nulligravid and nulliparous patient with malaise, hypermenorrhea, and intermittent cramping pain in the lower abdomen was referred to our clinic. Gynecological examination revealed a round cauliflower-like tumor, 7 cm in diameter, originating from the external cervical os with a rough surface and without a palpable stalk or base. Ultrasound scan showed a hyperechogenic mass within the uterine cavity with two distinct subunits: one (55 × 44 mm) well-demarcated from the surrounding structures and the other (43 × 38 mm) in close proximity to the lower part of the anterior uterine wall and in continuity with the myometrium. At surgery, the myoma was completely removed vaginally. Recovery was prompt, complete, and uneventful. Follow-up at one and three months confirmed normal gynecological and sonographic findings. In conclusion, vaginal myomectomy is the treatment of choice for prolapsed pedunculated submucous myoma; even extremely large nascent myomas can be efficiently removed vaginally.

Zusammenfassung

Die vaginale Entfernung eines riesigen Uterusmyoms wird hier beschrieben. Eine 25-jährige Nullipara/Nulligravida wurde mit folgenden Beschwerden vorstellig: sie fühlte sich nicht wohl, litt unter Hypermenorrhö und leichten krampfartigen Schmerzen im Unterleib. Der gynäkologische Befund ergab einen runden, blumenkohlförmigen Tumor mit einem Durchmesser von 7 cm an der Endozervix. Der Tumor hatte eine grobe Oberfläche und war ohne erkennbaren Stiel oder Basis. Die Ultraschalluntersuchung zeigte eine hyperechogene Masse in der Gebärmutterhöhle, die sich in 2 Partien gliederte: einen klar abgegrenzten Teil (54 × 44 mm) und einen sehr nah am unteren Teil der vorderen Gebärmutterwand gelegenen Teil (43 × 38 mm) mit Verbindung zum Myometrium. Der Tumor wurde chirurgisch vaginal entfernt. Die Genesung war schnell und problemlos. Die gynäkologischen und sonografischen Befunde bei den Kontrolluntersuchungen nach 1 und 3 Monaten waren normal. Fazit: Die vaginale Myomektomie stellt eine mögliche Therapie dar zur Behandlung von submukösen Prolapsmyomen; sie kann aber auch erfolgreich bei riesigen Myomen angewandt werden.

Key words

benign uterine tumor - nascent myoma - vaginal myomectomy

Schlüsselwörter

benigne Uterustumoren - entstehendes Myom - vaginale Myomektomie
 

  • References

  • 1 Rice KE, Secrist JR, Woodrow EL et al. Etiology, diagnosis, and management of uterine leiomyomas. J Midwifery Womens Health 2012; 57: 241-247
    CrossrefPubMedGoogle Scholar
  • 2 Golan A, Zachalka N, Lurie S et al. Vaginal removal of prolapsed pedunculated submucous myoma: a short, simple, and definitive procedure with minimal morbidity. Arch Gynecol Obstet 2005; 271: 11-13
    CrossrefPubMedGoogle Scholar
  • 3 Faivre E, Surroca MM, Deffieux X et al. Vaginal myomectomy: literature review. J Min Inv Gyn 2010; 17: 154-160
    PubMedGoogle Scholar
  • 4 Zimmermann A, Bernuit D, Gerlinger C et al. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Womens Health 2012; 12: 6
    CrossrefPubMedGoogle Scholar
  • 5 Shiota M, Kotani Y, Umemoto M et al. Estimation of preoperative uterine weight in uterine myoma and uterine adenomyosis. Asian J Endosc Surg 2012; 5: 123-125
    CrossrefPubMedGoogle Scholar
  • 6 Terzic M, Dotlic J, Maricic S et al. Hydatiform mole mimicking enlarged uterine fibromyoma four months after ART. Cent Eur J Med 2011; 6: 201-204
    CrossrefPubMedGoogle Scholar
  • 7 Sabry M, Al-Hendy A. Medical treatment of uterine leiomyoma. Reproductive Sciences 2012; 19: 339-353
    CrossrefPubMedGoogle Scholar
  • 8 Camanni M, Bonino L, Delpiano EM et al. Hysteroscopic management of large symptomatic submucous uterine myomas. J Minim Invasive Gynecol 2010; 17: 59-65
    CrossrefPubMedGoogle Scholar
  • 9 Brito LG, Magnani PS, de Azevedo Trapp AE et al. Giant prolapsed submucous leiomyoma: a surgical challenge for gynecologists. Clin Exp Obstet Gynecol 2011; 38: 299-300
    PubMedGoogle Scholar
  • 10 Rolli R, Favilli A, Acanfora MM et al. Vaginal myomectomy is a safe and feasible procedure: a retrospective study of 46 cases. J Obstet Gynaecol Res 2012; 38: 1201-1205
    CrossrefPubMedGoogle Scholar