CASE
REPORT
A 25 years old nulligravida presented with an
increasingly painful and uncomfortable giant mass at the perineum of more than
3-months duration. The symptoms have started gradually into no concomitant,
sexual activity or menstrual relationship. There was no history of straining or
pelvic manipulations ormassage.
No abnormal anatomical features were recorded
as physical and sexual development has been normal. Clinical examination
revealed a healthy young woman with normal findings on general review. This was a huge about the size of a big mango or avocado
pear (11.2cm by 7.6cm) slightly tender (figure 1)
Vaginal examination was practically
impossible because of lack of access. It was difficult to access or appreciate
the stalk beyond the introitus. Pelvic ultrasound and routine laboratory
investigation revealed to abnormalities.
A diagnosis of giant sub-mucous fibroid was
made with a differential of genital prolapse/uterine inversion. A quick scan of
the literature confirmed the rarity of the condition more so in this age group.
An indwelling catheter was put in place for continuous bladder drainage and
safety of the procedure under general anesthesia, the mass was further explored
into the vaginal canal and noted to be arising from the endometrium beyond the
cervical canal. The thick stalk was identified double-clamped, the mass
separated, and delivered the stump was secured with double ligations with
Chromic 2, suture. The woman has relief of the burden of the mass Fig. 2. She
recovered fully from anesthesia. Histology report confirmed leiomyoma on
cross-section
TREATMENT
Treatment in the case sited above, consisted
of examination under anesthesia and excision of the fibroid stalk relieving the
offending pain and discomfort. Delay in intervention would possibly have further
increased the ulceration and bleeding. Misfortune may arise in course of
misdiagnosis and wrong treatment. This case could be added to the rare causes
of genital mass.
On follow up 6weeks later, these were no
complaints though no sexual activity was recorded. She was satisfied with
treatment outcome and received counseling for other reproductive health
conditions.
DISCUSSION
Uterine smooth muscle tumors are one of the most
common human neoplasms. The prevalence of leiomyoma may be as high as 77%, when
tumors are counted after 2mm serial sectioning of consecutive surgical
hysterectomy specimen. [1]
Although many, if not most patients with
leiomyoma are asymptomatic, the residual symptomatic cases are sufficient to
result in a major public health concern for women of reproductive age.[1,2]
Symptomatic leiomyomas are associated with abnormal uterine bleeding, pelvic
pain and urinary dysfunction as noted in this case [2]. About 40-50% of all
leiomyomas have structural chromosomal rearrangements [3,4]. Invariably HIV is
associated with rare visceral leiomyoma and leiomyosarcoma in children with
AIDS this patient was HIV negative despite her age [6].
Extruding sub-mucous fibroid is rare in very
young women, with an incidence of 1.5 per 100,000 persons, The rarity of the
condition may be due to underreporting considering the high incidence of
fibroids in our practice. [7]
Of concern
was the discomfort from the mass and as well as lack of access into the
introitus. However, surprisingly the impact or menstrual function was
unremarkable.[8]
Sonographic report excluded genital prolapse,
uterine inversion and any malignancies or locally aggressive glandular cell
carcimorna.[9] Most reported cases of extruding fibroid describe an existing
extruding fibroid in antecedence.[10]
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