Spontaneous expulsion of a large vaginal mass – a case of complete ejection of a detached fibroma in statu nascendi.

Abstract

Objective: Pedunculated fibroids are a subtype of submucousal fibroids, that can prolapse into the cervical canal and vagina while remaining attached to the uterine cavity by a pedicle. This condition is known as fibroma in statu nascendi and its exact prevalence is unknown. As the most frequently presented symptoms are abnormal vaginal bleeding/discharge and lower abdominal pain, a complete release of the pedicle leading to spontaneous expulsion of an isolated fibroid is a rarity. Methods: A case report describing a complete, spontaneous release of a pedunculated fibroid measuring 8x5 cm. Results: A 63-year-old woman with no gynecological history was referred by her general practitioner after spontaneous expulsion of a large vaginal mass, which measured 8x5 cm. She had no vaginal bleeding since menopause and she had experienced a few days of whitish discharge and a sensation of something filling the vagina before the mass was expelled. Gynecological examination revealed a normal-appearing vagina and transvaginal ultrasound showed a thin endometrial echo. Histopathological diagnosis confirmed the suspicion of fibroma in statu nascendi. Conclusion: Prolapsed submucousal fibroids are a well-known condition, that frequently presents as abnormal vaginal bleeding/discharge and lower abdominal pain. Total, spontaneous detachment of the fibroid is rare. The diagnosis is typically evident; however, differential diagnoses, such as endometrial polyps and sarcomas, must be considered and clarified via histopathological evaluation.