Surgical technique - perineal leiomyoma after 4th degree laceration video

Abstract

Leiomyomas are the most common pelvic tumors; however, they are rarely found at the perineum. Fewer than 10 cases of perineal leiomyomas have been reported to-date. While lipomas have been described in the literature after trauma, however this is only the second case that identifies a possible association between trauma and perineal myoma development. The etiology is speculative, given the paucity of cases, though some have hypothesized a relationship between myoma formation and post-traumatic fibroblast proliferation. This video showcases the surgical technique for perineal mass excision and repair of the resulting anatomy, essentially a 4th degree laceration. A 33-year-old female presented with a large approximately six centimeter midline perineal mass. Her history was significant only for a 4th degree perineal laceration sustained thirteen years previously. Imaging studies and lesion location suggested the mass was an angiomyxoma, and she underwent mass excision and repair. Pathologic review ultimately revealed that the tumor was most consistent with a leiomyoma. We aim to showcase our patient’s presentation, radiologic imaging, surgical care, pathologic investigation, and follow-up surveillance. Perineal leiomyomas are exceedingly uncommon and only one previously documented case after perineal trauma has been reported in the literature. We hereby offer an expansion of the differential when considering masses in the perineum as well as demonstrate the surgical excision and detailed repair of the equivalent 4th degree perineal laceration.