Paraurethral Leiomyoma Research Articles

Paraurethral leiomyoma in a post-menopausal woman: a case report

BackgroundParaurethral leiomyoma are rare, benign, hormone-dependent growths. They originate from smooth muscle cells and occur in the paraurethral space of the urethra. They make up approximately 5% of urethral tumours. They usually appear in the reproductive age group of women with variable clinical presentation depending on the size and location of occurrence. They can either be asymptomatic or can present with local pressure symptoms, dyspareunia, and lower urinary tract symptoms. The usual treatment is surgical excision with confirmation of diagnosis on histology.Case presentationWe report a case of a 58-year-old lady who initially presented to the gynaecology department with pelvic pain and lower urinary tract symptoms. After initial investigation with an ultrasound scan and MRI, a 5 × 5 × 4 cm mass was detected next to the bladder, with suspicions of it arising from the detrusor muscle. There was also a 3 cm Bartholin’s cyst detected in the left vaginal wall. Her care was referred to the urology team who after further investigation and a transperineal biopsy of the mass diagnosed a paraurethral leiomyoma on histology. Given the patient was symptomatic, she opted for treatment. Embolisation was explored but was deemed not feasible due to a complex blood supply. Therefore, the patient underwent an open excision of leiomyoma as a combined abdominal and vaginal procedure.ConclusionParaurethral leiomyoma are rare benign lesions and therefore pose diagnostic challenges as they must be differentiated from malignant tumours. Radiological imaging aids with diagnosis but diagnosis is confirmed on histology. The mainstay of treatment is surgical excision. This case is unusual given the patient’s age and post-menopausal status as the average age of presentation in the literature is 41 years old. The authors would recommend initial USS imaging for all patients presenting with overactive bladder symptoms and pelvic pain/discomfort.

腹腔鏡用超音波検査が診断と術式選択に有用であった傍尿道平滑筋腫の1例

今回我々は，術中に腹腔鏡用超音波検査を使用することで稀な傍尿道腫瘍と判断し治療した症例を経験したので報告する．症例は39歳女性，4経妊1経産，当科を受診する約1年前より頻尿を自覚していた．検診にて膀胱を圧排する骨盤内腫瘍を指摘され，精査加療目的に当科を紹介受診した．経腟超音波断層法検査とMRI検査で前腟壁内の尿道直下に直径約5 cm大の境界明瞭な腫瘤を認めた．頻尿の症状があり，腫瘍は増大傾向であるため摘出する方針とした．膀胱や尿道にも近接するため腹腔鏡補助下に腫瘍を摘出する方針とした．腹腔鏡下に腟壁から尿道付近まで前腟と膀胱とを剥離したが，腫瘍と腟壁に連続性がなく，術中に施行した腹腔鏡用超音波検査で剥離した膀胱周囲組織内に腫瘍が存在していた．腟由来ではなく傍尿道腫瘍であると判断し，尿道周囲操作が可能な経腟アプローチに切り替え腫瘍摘出に至った．病理組織検査では平滑筋腫であり悪性所見はなかった．今回の症例は術中に施行した腹腔鏡用超音波検査により傍尿道腫瘍と診断できた．腹腔鏡用超音波検査は腹腔内を観察するだけでなく比較的稀とされる腟内や傍尿道，膀胱周囲に存在する腫瘍同定にも有用である．

Paraurethral leiomyoma in a 22-year-old woman: A case report

Leiomyoma is a benign fibromuscular neoplasm originating from smooth muscle cells. Paraurethral leiomyoma is an extremely rare, benign, hormone-dependent​ growth from the mesenchymal cells in paraurethral space of female urethra. They usually appear in the reproductive age group women, mean age of presentation being approximately 41 years. A 22-year-old woman presented with palpable mass at vagina and weak urinary stream. She underwent clinical examination and MRI imaging followed by transvaginal excision of the mass. Histopathological examination confirmed paraurethral leiomyoma. Paraurethral leiomyoma make up approximately five percent of urethral tumors. This case depicts the presentation and treatment of a paraurethral leiomyoma in one of the youngest women reported in the literature.

Paraurethral leiomyoma in a 52 year-old woman: Clinical and diagnostic features and surgical treatment

Leiomyomas are benign tumors of smooth muscle origin occurring throughout the genitourinary system. Sometimes paraurethral leiomyoma can cause a bulking effect on the bladder without gross involvement of the urethra. In our work we describe the case of a woman with a vulvar mass found after self-examination. She was investigated pelvic Magnetic Resonance Imaging (MRI) which showed a well encapsulated solid mass, about 24mm (maximum diameter) located at paraurethral level, on right anterolateral side, It showed uptake of contrast, with a compressive-dislocative effect on the urethra, without involvement of the sphincters. Surgery was performed with excission “en-block” of the mass. The procedure was well tolerated under spinal anesthesia and the patient was discharged 24h later, after removing the bladder catheter. No signs of haematuria nor symptoms of incontinence were reported in the following weeks. Pathology of the excised specimen revealed complete resection of a benign, submucus leiomyoma. Although leiomyomas are very common in organs such as the uterus, the presentation of a urethral leiomyoma, as found in the present case, is very rare. The description of these lesions is however important to create a scientific path that can clarify the cause and the evolution. It can also represent an evolution for imaging through MRI, improving its framework and distinguishing it from malignant tumors that require another surgical strategy.

Paraurethral Leiomyoma: An Extremely Rare Extrauterine Leiomyoma

Leiomyomas occur most frequently in the genitourinary and gastrointestinal system. Amongst all the leiomyoma cases, the most common site of occurrence is the genital tract (95%), while the remaining tend to occur at various other sites of the body. However, paraurethral leiomyomas are extremely rare benign mesenchymal tumours and only few cases have been reported in the literature. Herein, we describe a case of paraurethral leiomyoma in an asymptomatic 29-year- old female. MRI revealed a well-defined signal soft tissue intensity lesion in lower 1/3 rd of urethra and vagina measuring approximately 2.67 SI x 2.3 AP x 1.9 TR cms, in the space between urethra and vagina, closely abutting both the structures. Mass was excised under spinal anaesthesia. Histopathological examination along with immunohistochemical positivity with smooth muscle antigen confirmed the diagnosis of leiomyoma.

Особенности клинического течения, хирургического лечения и морфологической диагностики парауретральной лейомиомы у женщин

This article presents a rare clinical case of non-epithelial tumor, a paraurethral leiomyoma, in a 44-year-old woman. The tumor was observed for a long time with an incorrect diagnosis of paraurethral cyst. The preoperative examination indicated a differential diagnosis between the paraurethral cyst, urethral diverticulum, and the neoplasm located on the anterior vaginal wall. The surgical intervention with tumor removal made it possible to make the correct diagnosis. The pathomorphological examination did not allow us to determine the nature of mesenchymal tumor definitively and unambiguously. The diagnosis of paraurethral leiomyoma was established only with a comprehensive immunohistochemical study with an extended range of markers. Key words: paraurethral leiomyoma, immunohistochemical study, spindle cell mesenchymal tumor

Female paraurethral leiomyoma: a case report

BackgroundLeiomyoma is a benign fibromuscular neoplasm originating from smooth muscle cells. Paraurethral leiomyoma is an extremely rare, benign, hormone-dependent growth from the mesenchymal cells in paraurethral space of female urethra. They usually appear in the reproductive age group women, mean age of presentation being approximately 41 years.Case presentationA 48-year-old woman presented with palpable mass at vagina and weak urinary stream. She underwent clinical examination and CT scan and MRI imaging followed by transvaginal excision of the mass. Histopathological examination confirmed paraurethral leiomyoma.ConclusionsParaurethral leiomyoma owing to its rare incidence poses a diagnostic dilemma for the gynecologists. Radiological imaging techniques help in diagnosis. Surgical excision via vaginal route is the treatment of choice. Diagnosis is confirmed by histopathology.

Posterior Distal Para-Urethral Leiomyoma in Virgin Female Patient: A Case Report

Posterior Distal Para-Urethral Leiomyoma in Virgin Female Patient: A Case Report

Paraurethral Leiomyoma During Pregnancy: A Case Report and Review of the Literature

Abstract Background: A leiomyoma is a benign tumor of smooth-muscle cells that can arise from the genitourinary or gastrointestinal systems. Leiomyomas arising from the urethra or paraurethral area...

Paraurethral Leiomyoma as an Uncommon Cause for Female Urethral Obstruction: Report of Two Cases

Paraurethral Leiomyoma as an Uncommon Cause for Female Urethral Obstruction: Report of Two Cases

Paraurethral Leiomyoma in a Young Female: A Case Report

Paraurethral Leiomyoma in a Young Female: A Case Report

A True Paraurethral Leiomyoma, A Case Report and Review of Literature

A True Paraurethral Leiomyoma, A Case Report and Review of Literature

Female paraurethral leiomyoma: treatment and long-term follow-up.

We describe our experience with evaluating the ideal management of female paraurethral leiomyomas from imaging to surgery and follow-up. Between January 2009 and January 2012, we treated six women (age range 32-49years) affected by paraurethral leiomyoma of different sizes. All the six patients underwent transvaginal excision of the mass. They are free of recurrence at follow-up (range 32-72months). Two patients developed stress urinary incontinence after the excision: in both cases, incontinence was corrected by a tension-free vaginal tape-obturator (TVT-O) placement. In one patient, a fascial sling was necessary to repair a urethral lesion that developed during surgical excision of the mass. A well-defined protocol for diagnosing and managing a paraurethral mass had not been established as yet due the rarity of the mass. We suggest performing pelvic magnetic resonance imaging (MRI) as a primary examination, followed by lesion biopsy. Complete surgical resection performed transvaginally should be the treatment of choice. As paraurethral leiomyomas does not originate from intraurethral smooth-muscle component, urethral lesion is rare. Excision of female urethral leiomyoma transvaginally is safe, and postoperative urinary incontinence, if any, can be easily corrected with minimally invasive tecniques.

Paraurethral leiomyoma in a postmenopausal woman: first European case.

Leiomyomas are benign tumors extending from smooth muscle cells and only few cases of paraurethral leiomyomas have been described in the literature. They are often seen in the reproductive age and around 50% of the cases are asymptomatic. We describe a 59-year-old woman with a solid mobile tumor below the symphysis revealed at a gynecological examination. Transvaginal ultrasound and MRI confirmed the tumor and excision of the paraurethral tumor was carried out. The histological examination showed a benign paraurethral leiomyoma. The postoperative period was characterized by urethral pain as well as vaginal leakage of urine.

Paraurethral Leiomyoma

Paraurethral leiomyoma is a rare, benign, hormone-dependent neoplasm of mesenchymal origin affecting women. The clinical evidence varies, but it tends to be asymptomatic or associated with the sensation of a foreign body; urinary symptoms are rarely described. The distinction among urethral, paraurethral, and anterior vaginal wall leiomyoma can be very difficult owing to their anatomic proximity. Excision of the mass is the recommended treatment, and the diagnosis is confirmed by the pathologic finding to rule out the presence of a sarcoma. A case of paraurethral leiomyoma associated with dysuria, dyspareunia, and obstructive voiding symptoms is reported.

Para-Urethral Leiomyoma: A Case Report and Discussion of Diagnosis and Management

Para-Urethral Leiomyoma: A Case Report and Discussion of Diagnosis and Management

Paraurethral leiomyoma in a female causing urinary obstruction

We report a case of paraurethral leiomyoma in a female patient, in which the first symptoms were dysuria and sensation of incomplete voiding. The physical examination revealed a mass in the anterior vaginal wall. The diagnosis was made through ultrasonography and pelvic MRI and confirmed by transvaginal ultrasound-guided needle biopsy. The surgical excision was accomplished without opening the urinary tract. A review of the relevant published studies and a suggestion for the appropriate management of these cases are included.

Urethral and paraurethral leiomyomas in the female patient

Urethral leiomyomas in women arise from the smooth muscle of the urethra and are rare, benign urethral tumors seen primarily in women. We present three cases of urethral leiomyomas identified over a 30-year period at our institution. A 45-year old woman presented with a 1 year history of frequency, nocturia, and hesitancy and was found to have both a 2-cm proximal urethral and a 3-cm posterior bladder leiomyoma. She developed stress urinary incontinence postoperatively and was treated with a Burch colposuspension. A 33-year old woman with hematuria was found to have both a 3-cm urethral and a 3-cm paraurethral leiomyoma at the bladder neck. A 21-year old without urinary complaints was found to have a 3-cm leiomyoma at the urethral meatus. Urethral leiomyomas must be differentiated from paraurethral leiomyomas, which are often asymptomatic and may be removed without disrupting the urethral mucosa or smooth muscle. The removal of urethral myomas may be complicated by the development stress urinary incontinence or urethral stricture.

FEMALE PARAURETHRAL LEIOMYOMA: IMMUNOHISTOCHEMICAL APPROACH TO THE RELATIONSHIP BETWEEN LEIOMYOMA AND OVARIAN HORMONES

The majority of leiomyomas are uterine in origin, and paraurethral leiomyoma is relatively rare. Leiomyoma mainly occurs during the reproductive period. Its development has been suggested by some investigators to be related to ovarian hormones,1 while others have reported no relationship. We report a case of female paraurethral leiomyoma and the results of immunohistochemical analysis using ovarian hormone receptors. CASE REPORT A 49-year-old married woman, gravida 0, who had last menstruated 2 months previously presented with a mass on the vulva. Hormonal status was that of a woman in menopause. Serum levels of follicle-stimulating hormone and luteinizing hormone were slightly higher than the normal limit of standard menstruants, and estradiol was at the lowest limit of normal. The patient had no history of illness involving the urinary tract. Physical examination revealed a tender reddish walnutsized mass that was floating and elastic firm, had a smooth surface and was situated on the right side of the urethral meatus. The mass was palpated to about 3 cm. from the ostium vaginae on digital vaginal examination. The urethral meatus was then shifted to the left, causing a shift in the urinary stream. Axial plain computerized tomography (CT) revealed a 2.5 2.0 cm. well-defined, homogeneously low density mass on the right side of the urethra, while contrast enhanced CT showed a slightly enhanced mass. T2-weighted magnetic resonance imaging (MRI) demonstrated a heterogeneously iso or mildly hypointense lesion (fig. 1, A). The central part of the lesion was hypointense on T2-weighted MRI, and was not as enhanced as the rest of the lesion on contrast enhanced T1-weighted MRI (fig. 1, B). The preoperative diagnosis was a paraurethral tumor. A small longitudinal incision was made on the vaginal vestibule. The mass, which was sharply delimited, was easily enucleated. Histological examination revealed marked proliferation of the bundles of smooth muscle cells, especially at the center of the tumor. In the rest of the tumor the proliferation was not as marked, and there was a myxoid matrix around the smooth muscle cells. These findings coincided with the difference in the enhancing effect on contrast enhanced T1-weighted MRI. The tumor was histopathologically diagnosed as a paraurethral leiomyoma. The nuclei of the tumor cells were stained with estrogen receptor (ER), estrogen receptor (ER) and progesterone receptor (PR) by the immunohistochemical technique (fig. 2). There was no recurrence of symptoms or tumor at 6-month followup.

Para-urethral vaginal leiomyoma

Only a few cases of para-urethral vaginal leiomyoma have been reported in literature. We describe two additional cases and discuss the differential diagnosis and management.