Vaginal Wall Mass Research Articles

Can Gartner’s Duct Cyst Trigger Marital Disharmony? A Case Report

Gartner’s duct cyst (GDC) is a remnant of the mesonephric (Wolffian) duct in females. The GDC is formed from the persistence of some portions of the mesonephric duct in adult females resulting in small-sized cysts usually in the anterolateral vaginal wall but could be found elsewhere along the tract of the duct. The case of a 33-year-old para 5+1 (three alive) woman who had GDC is reported. The patient presented with incidental findings of a vaginal mass during gynecological evaluation and subsequently had dyspareunia. A provisional diagnosis of GDC was made and this was confirmed by transvaginal ultrasound. The patient had transvaginal excision of the cyst and histological confirmation of a benign cystic lesion with the diagnosis of GDC. GDC is a rare entity and clinical examination revealing a cystic vaginal wall mass with or without symptoms should raise a high suspicion of this condition.

Vulvar Leiomyoma Mimicking a Bartholin’s Gland Tumour

Bartholin's cyst is frequently the cause of unilateral vulval enlargement in a woman of reproductive age. We discuss a noteworthy occurrence of vulval leiomyoma that was initially misdiagnosed as a recurrent Bartholin's cyst in this article. Intraoperatively, it was observed that the 35-year-old lady who had been scheduled for marsupialization really had a tumour of vulvar or bartholin's gland origin rather than a cyst. It was discovered to be rather hard in consistency and well encapsulated intraoperatively. The vulvar leiomyoma was proven to be the diagnosis by histopathology. Extrauterine leiomyomas are uncommon and more challenging to diagnose. Bartholin's cysts, fibromas, lymphangiomas, soft-tissue sarcomas, and neurogenic tumours are among the differential diagnoses. Following surgery, it is advised that all patients have long-term follow-up. Keywords: Vulvovaginal leiomyoma, Vaginal wall mass, Benign tumor, Bartholin’s gland, Vulvar mass, Misdiagnosis, Excision, Enucleation, Bartholin’s cyst

Revival of a Surgical Technique: Marsupialization of Female Urethral Diverticula

<h3>Study Objective</h3> To review the etiology, incidence, basic evaluation and the current treatment options for female urethral diverticula. As well as to describe a case-presentation of female urethral diverticulum and to demonstrate a technique for marsupialization. <h3>Design</h3> A case presentation and educational surgical video <h3>Setting</h3> Single academic institution <h3>Patients or Participants</h3> Single patient <h3>Interventions</h3> Marsupialization of female urethral diverticulum <h3>Measurements and Main Results</h3> We present a case of a 31-year-old female with a painful anterior vaginal wall mass, urinary urgency/frequency and some leakage of urine during pregnancy. MRI was notable for a 3.7 × 2.7cm anterior vaginal wall mass concerning for urethral diverticulum. After her vaginal delivery she underwent aspiration for decompression; however, she then had recurrence of the diverticulum 6-weeks later resulting in repeat drainage. At that time, she referred to Urogynecology. Her exam was notable for a recurrent diverticulum. She as counseled extensively on her options for treatment and decision was ultimately made to proceed with marsupialization due to her current social circumstances, desire not to undergo a more complex surgery nor to have prolonged Foley catheter use. She underwent an uncomplicated marsupialization of her urethral diverticulum and was discharged home the same day and her foley was removed at home on postoperative day zero. She was seen for follow-up at 2-weeks and 6-weeks and was healing well without urinary incontinence or notable recurrence symptoms or diverticulum. <h3>Conclusion</h3> Marsupialization is a simple, quick, and effective treatment option for urethral diverticula with minimal surgical risk and should be considered in appropriately counseled patients as an initial treatment option for female urethral diverticula.

Anterior Vaginal Wall Mass Presenting as Prolapse in an Adolescent

Background: True pelvic organ prolapse in nulligravid young females is uncommon but if present, is typically due to underlying risk factors such as chronic lung disease, heavy lifting, malnutrition, congenital spinal defects or pelvic structural anomalies. Secondary prolapse may be due to benign or malignant para-vaginal masses or hernias and should be evaluated with imaging. Interlabial vaginal masses that are symptomatic should be managed surgically, and multidisciplinary approach is always preferred.

Vaginal dermoid cyst

A 27-year-old gravida 1 para 1 presented with a painless, left anterolateral vaginal wall mass, measuring 10 cm in diameter, which had been slowly growing over several years. Pelvic magnetic resonance images were concerning for a large Gartner’s duct cyst based on the location and appearance of the mass (Figure 1). After an uncomplicated vaginal cystectomy, the mass grossly revealed spillage of sebaceous material and the presence of hair (Figure 2). Further pathohistologic evaluation confirmed the diagnosis of a rare vaginal dermoid cyst (mature cystic teratoma) given the presence of squamous epithelium, sebaceous glands, hair follicles, capillaries, and adipose tissue, representing all 3 embryonic layers (Figures 3 and 4).

Endometriosis of the vesico-vaginal septum: a rare and unusual localization (case report)

BackgroundWe report a rare and unusual case of endometriosis in the vesico-vaginal septum. The location of this disease at this site is so uncommon that the literature about is very rare.Case presentationA 41-year-old female was presented with urinary symptoms. There was history of caesarean section. Physical examination revealed an anterior vaginal wall mass. Pelvic MRI showed an inter vesico-vaginal mass, suggesting a leiomyoma. Surgical excision was performed by the vaginal route. There were no postoperative complications. Histopathology examination showed focal endometriosis.ConclusionEndometriosis of the anterior compartment remains relatively rare; its localization to the vesico-vaginal septum (VVS) is very rare. With the occurrence of nonspecific cyclic urinary signs in women during periods of genital activity, endometriosis should be mentioned, especially in the presence of an antecedent of pelvic surgery.

44: Vaginal cyst presenting as pelvic organ prolapse

The purpose of this video is to describe an unusual case of a large vaginal cyst presenting as pelvic organ prolapse and to demonstrate techniques for vaginal reconstruction. A 47-year-old gravida 4 para 2 presented with pelvic fullness, which she thought was prolapse. On pelvic exam, a 4-centimeter cystic mass was located on the posterior vagina and protruded past the hymen. Magnetic resonance imaging showed a 3.5 x 2.8 x 3.8 cm posterior vaginal wall cyst without solid components, septations, nodularity, or other suspicious features. The patient desired corrective surgery, so she underwent vaginal excision of the cyst. When in the operating room, exam under anesthesia confirmed the posterior vaginal wall mass. There was no evidence of pelvic floor prolapse. The vaginal mucosa overlying the cyst was incised. Allis clamps were placed on the mucosal edges bilaterally to provide traction. The cyst wall was sharply dissected off the vaginal mucosa. During the dissection, the cyst cavity was entered and a large amount of fluid was expulsed. The cyst was completely excised from the underlying tissue. The rectovaginal fascia was reinforced and plicated with interrupted 2-0 absorbable sutures. The posterior vaginal mucosa was trimmed and re-approximated with a running locking 2-0 absorbable suture. Hemostasis was ensured along the suture line. Rectovaginal exam confirmed no injury to the rectum. The patient was discharged home in a stable condition. Pathology demonstrated a benign simple cyst and benign vaginal mucosa without dysplasia. She was seen for a postoperative visit, at which time there was a healing but intact suture line along the posterior vaginal mucosa. It is important to include vaginal cysts in the differential diagnosis of pelvic organ prolapse. Vaginal removal and reconstruction can be performed successfully.

Unusual Presentation of Myeloid Sarcoma in a Patient With Usher Syndrome

Abstract A 45-year-old woman with Usher syndrome, associated congenital deafness, progressive blindness due to retinitis pigmentosa, and latent autoimmune diabetes presented to the emergency department with malaise, dizziness, and pelvic pain following removal of an intrauterine device. A posterior vaginal wall mass was found on examination. Laboratory values demonstrated anemia, thrombocytopenia, and an elevated white blood cell count, raising concern for infection and potential onset of diabetic ketoacidosis. This prompted a peripheral blood smear review, which showed 60% monocytic blasts. A subsequent vaginal mass biopsy showed a myeloid sarcoma. Molecular studies demonstrated an NPM1 mutation in exon 12 without FLT3 mutation or internal tandem duplication. While a diagnosis of acute myeloid leukemia with mutated NPM1 was considered, cytogenetics revealed a complex karyotype with evidence of clonal evolution, consistent with acute myeloid leukemia with myelodysplasia-related changes. In addition to an unusual presentation of myeloid sarcoma, this case posed significant questions regarding management and pursuit of hematopoietic stem cell transplantation. Usher syndrome is genetically and clinically heterogeneous. While it is not known to be associated with increased risk of malignancy, mutation of genes associated with Usher syndrome has been identified in acute leukemia. Our case raises the question as to whether potential germline predisposition should be considered in a patient with a previously unassociated congenital syndrome.

Rare myeloid sarcoma with KMT2A (MLL)-ELL fusion presenting as a vaginal wall mass

BackgroudMyeloid sarcoma (MS) is a rare neoplasm of immature myeloid precursors that form tumor mass outside the bone marrow. The diagnosis of de novo MS can be challenging, particularly in patients with no prior history of hematologic malignancies or when MS involves unusual anatomic sites.Case presentationThe patient was a 53-year-old woman with a history of uterine fibroids and vaginal bleeding for many years who presented with a vaginal wall mass. The tumor had histologic and phenotypic features of histiocytic sarcoma, however, overlapping with a possible extramedullary MS. Using a comprehensive genomic profiling, we were able to identify recurrent chromosomal aberrations associated with MS including a rare KMT2A-ELL fusion, losses of chromosomes 1p, 9, 10, 15, 18, and gain of chromosome 1q and mutations in FLT3 and PTPN11, and achived the final diagnosis of a de novo MS. The patient received standard treatment for acute myeloid leukemia regimen with stem cell transplantation and achieved complete remission.ConclusionOur case illustrates the clinical utility of comprehensive genomic profiling in assisting the diagnosis or differential diagnosis of challenging MS or histiocytic sarcoma cases, and in providing important information in tumor biology for appropriate clinical management.

A complicated urethrovaginal fistula following an inappropriate urethral diverticulum management

ObjectiveUrethral diverticulum is uncommon, therefore appropriate evaluation, preoperative planning and counseling must be done in order to make correct diagnosis and prevent complications. Materials and methodsA case of anterior vaginal wall mass was treated elsewhere by a gynecologist as periurethral cyst abscess; incision and drainage were done but a symptom of pus discharge was observed after 2 weeks. Therefore, exploration, cyst wall excision and primary closure were done though histopathological examination surprisingly confirmed the presence of urethral tissue suggestive of diverticulum. ResultsSubsequently, she developed persistent urinary leakage along with urethrovaginal fistula for which they again performed pervaginal multilayer closure. Patient was later referred to us with recurrent urethrovaginal fistula. We performed posterior urethral fistulectomy with anterior vaginal wall flap and multilayer closure. Three years follow up reveals complete recovery. ConclusionEven urethral diverticulum is a rare condition, should be kept in mind as early diagnosis and management.

Vaginal leiomyoma presenting as a lateral vaginal wall mass

Leiomyomas are classified as benign mesenchymal neoplasms and consist of smooth muscle cells with variable amounts of fibrous stroma. The tumours occur most frequently in the uterus, affecting 20–30% of women of reproductive age but vaginal leiomyomas are rare with only around 300 cases reported since the first case was described in 1733. These tumours are thought to arise from Mullerian smooth muscle cells in the sub-epithelium of the vagina. Vaginal leiomyomas are usually situated in the anterior vaginal wall. This article reports a case of primary leiomyoma arising from the left lateral vaginal wall, which presented with vaginal discharge and a lateral vaginal wall mass.

Female Urethral Diverticula in the Contemporary Era: Is the Classic Triad of the “3Ds” Still Relevant?

To evaluate the correlation between signs and symptoms of urethral diverticulum (UD), especially the classic triad of 3Ds including dysuria, dyspareunia, and postvoid dribbling, before and after transvaginal urethral diverticulectomy, in relation to anatomic configuration on imaging. After IRB approval, records of 54 females who underwent transvaginal urethral diverticulectomy were retrospectively reviewed. Urinary symptoms before and after the procedure were correlated with the anatomical configuration of the UD on magnetic resonance imaging. The median age of the patients was 52 years (range 29-77). Common presenting symptoms were stress urinary incontinence (60%), dyspareunia (60%), and recurrent urinary tract infections (70%). The classic 3Ds were present collectively in only 5% of patients. Dyspareunia was the most common of the 3 "Ds." Twenty-seven percent of patients had none of the classic 3Ds. On physical examination, the most common finding was a tender anterior vaginal wall mass (52%). Presenting signs and symptoms did not correlate with anatomic configuration in terms of radial urethral involvement, size, or length of urethral involvement on preoperative magnetic resonance imaging. After median 14 months of follow-up, no patient reported the classic 3Ds after surgery. Recurrent urinary tract infections, stress urinary incontinence, dyspareunia, and vaginal mass are the most common presentations of UD. The classic triad "3Ds" is rarely seen in the individual patient. Preoperative anatomic configuration on imaging is not correlated with the severity or nature of presenting symptoms.

Subpubic Cartilaginous Cyst—A Rare Periurethral Lesion With Implications for Surgical Approach

CASE PRESENTATION A 62-year-old African American woman was referred for evaluation of a periurethral vaginal mass that was discovered on workup for vaginal pain. She described her vaginal pain as a sensation of constant pressure in the anterior wall of her vagina that varied in severity throughout the day and had worsened over the past months. Her pain was associated with dyspareunia, as well as bothersome storage and voiding symptoms. Additionally, she had a history of urinary incontinence that occurred with both coughing and sneezing as well as with preceding urgency. Her medical history included hypertension, sleep apnea, gastroesophageal reflux, and asthma, and her surgical history was remarkable for a total abdominal hysterectomy that was performed for uterine fibroids. She never used tobacco products and did not consume alcohol or use illicit drugs. Her three children were delivered vaginally. Family history was notable for a grandmother with uterine cancer. Review of systems was negative for gross hematuria, postvoid dribbling, and vaginal bleeding. Physical examination was remarkable for a 3 cm × 3 cm firm, round, anterior vaginal wall mass, which was tender to palpation and compressing the urethra. Fluid could not be expressed per urethra upon palpation of the mass. Her uterus and cervix were surgically absent, she did not have pelvic organ prolapse, and bimanual exam did not reveal any intrapelvic pathology. Postvoid residual urine was 200 mL, and urine analysis demonstrated 3-5 red blood cells with no pyuria. Pelvic magnetic resonance imaging (MRI) revealed a 3.0 × 2.4 × 3.2 cm bilobed complex cystic lesion suggestive of urethral diverticulum (Fig. 1), although no clear communication with the urethra could be identified. Additionally, MRI revealed a 1 cm left posterolateral bladder diverticulum. On urodynamic evaluation, she was obstructed according to the Blaivas-Groutz nomogram: her maximum detrusor pressure was 50 cm of water and her peak urinary flow was 2 mL/second. She did not demonstrate stress incontinence or detrusor overactivity.

Placental site trophoblastic tumor and choriocarcinoma: an unusual presentation.

BackgroundMixed trophoblastic tumor composed of choriocarcinoma and placental site trophoblastic tumor was diagnosed on histopathology slides review, is a very rare mixed tumor and cured after adjuvant chemotherapy.Case presentationTwenty-nine years old, Para 2 female presented with 4 months history of irregular vaginal bleeding after an uncomplicated vaginal delivery. Abdominal examination showed 14 weeks uterus with β-hCG level of 14,889 mIU/ml. Slides review confirmed the diagnosis of placental site trophoblastic tumor (PSTT). Patient underwent total abdominal hysterectomy and resection of anterior vaginal wall mass. Post operative (48 h) β-hCG level was 6016 mIU/ml. Final pathology showed mixed trophoblastic tumor composed of choriocarcinoma (CC) and PSTT. Adjuvant chemotherapy started and continued for three cycles after achieving normal β-hCG.ConclusionPSTT is a rare disease and potentially curable. Differential diagnosis in women presented with vaginal bleeding and a uterine mass in the post partum period must include gestational trophoblastic disease.

Vaginal angiomatosis: differential diagnosis of a rare case.

Vaginal angiomatosis is regarded as part of a very rare entity of benign vascular tumors of the female genital tract. The incidence of these tumors is extremely low. The rarity of this disease and lack of distinctive features poses a problem of differential diagnosis. We present the case of a 51-year-old female with grade III uterine prolapse and a bleeding vaginal wall mass. Violaceous irregular soft tissue with hemorrhagic spots was observed in the lower third of the posterior vaginal wall. The patient underwent surgery for colpohysterectomy with vaginal wall mass excision. Surgical excision was curative, and no recurrences were observed after 12 months of follow-up. The aim of our study is to present a rare but representative case. This will hopefully increase the level of awareness regarding this condition so that physicans will keep it in mind during differential diagnosis of similar clinical cases. Furthermore, it highlights the important role of pathological examination for the definitive diagnosis of angiomatosis.

V2-14 VAGINAL EXCISION OF PERIVESICAL MASS

You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2015V2-14 VAGINAL EXCISION OF PERIVESICAL MASS Mahmoud Mohamed and Ayman Mahdy Mahmoud MohamedMahmoud Mohamed More articles by this author and Ayman MahdyAyman Mahdy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.339AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with perivesical or periurethral mass compressing the bladder neck can present with storage and/or voiding lower urinary tract symptoms (LUTS). We report a case of 49-year-old woman presented with mixed LUTS. Vaginal exam revealed a small firm anterior vaginal wall mass on the right and at the level of the bladder neck. Vaginal exam was otherwise unremarkable. Post void residual volume was 135 ml. Pelvic MRI showed a 3x3 cm mass at the right side of the bladder compressing the bladder neck. MRI suggested the diagnosis of leiomyoma. Transvaginal ultrasound guided biopsy was diagnostic for leiomyoma. In this video, we present our technique of excision of a perivesical mass using the vaginal approach. METHODS With the patient in the lithotomy position, a right paramedian anterior vaginal incision was made. Dissection was carried down to the level of the mass. The mass was completely removed. The bladder defect was closed. Cystoscopy confirmed patency of the ureters and watertight bladder closure. The dead space left after mass removal was closed in multiple layers. Foley catheter was left in place for one week after which cystogram confirmed absence of extravasation and Foley was removed. RESULTS Patient had vaginal excision of the perivesical mass. Operative time was 1 hour and 45 minutes. Estimated blood loss was 100 ml. Patient's voiding and storage symptoms were resolved at 2- month follow up. CONCLUSIONS Vaginal approach is a viable option for excision of vaginally accessible perivesical masses. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e101 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mahmoud Mohamed More articles by this author Ayman Mahdy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

3. Clear cell adenocarcinoma of urinary tract: 2 cases involving urethra and bladder

<h3>Background</h3> Adenocarcinoma of urothelial tract is considered primary when conventional urothelial carcinoma component is not identified. Cases with co-existing urothelial carcinoma are regarded as differentiation of urothelial origin. Clear cell adenocarcinoma is a rare variant that needs to be discriminated from primary adenocarcinoma of urinary tract, urothelial carcinoma with glandular differentiation and metastatic tumours. <h3>Methods</h3> We report two cases of clear cell adenocarcinoma of urinary tract, involving urethra (Case 1) and urinary bladder (Case 2). Histological features, immunohistochemical profile and clinical outcome are summarised. <h3>Results</h3> Case 1 (urethral tumour): A 64-year-old Chinese female presented with anterior vaginal wall mass. Biopsy showed clear cell adenocarcinoma and she underwent neoadjuvant chemotherapy. Resection showed urethral tumour involving bladder neck and one lymph node. Histologically, tumour showed tubulopapillary and glandular architecture, hobnail nuclei and clear cytoplasm. Immunohistochemically, tumour cells were CK7 and CA125 positive, thrombomodulin and HMWCK weak positive, and CK20 and p63 negative. Patient is under follow-up. Case 2 (bladder tumour): A 56-year-old Chinese female underwent surgery for bladder mass. Tumour showed tubulopapillary and glandular architecture, hobnail nuclei and clear cytoplasm. Two lymph nodes were positive. Immunohistochemical profile was CK7 positive and CK20 negative. Patient expired following peritoneal carcinomatosis. Conclusions: Clear cell adenocarcinoma of urinary tract can be identified by a constellation of features: (1) presence of tubulo-papillary/glandular architecture, high grade hobnail nuclei and clear cytoplasm, (2) absence of primary adenocarcinoma of urinary tract, conventional urothelial carcinoma with glandular differentiation and metastasis, and (3) immunohistochemical profile of positive CK7 and CA125, weak positive HMWCK and CK5/6, negative CK20 and p63 and negative staining for potential metastatic tumour (e.g., CDX2 negative). Clinical behaviour is aggressive. Correct identification can aid in trial of neoadjuvant chemotherapy.

Management of Embryonic Mullerian Cyst Presenting as an Anterolateral Vaginal Wall Mass

Management of Embryonic Mullerian Cyst Presenting as an Anterolateral Vaginal Wall Mass

An unusual presentation of a urethral diverticulum as a vaginal wall mass: a case report

IntroductionThe diagnosis of urethral diverticulum can be challenging given the vague or absent presenting symptoms. In addition, vaginal cancer can present with elusive symptoms--some parallel to urethral diverticula. A case of a bleeding ulcerated mass anticipated to be a vaginal cancer was instead identified as a benign urethral diverticulum. To the best of our knowledge, this is the first case report of a benign urethral diverticulum presenting as a bleeding, necrotic ulcerated mass.Case presentationA 52 year-old multiparous African-American woman presented with a 2-day history of heavy vaginal bleeding passing large clots and suprapubic pain. A pelvic examination revealed blood clots in the vagina along with a friable, fibrous ulcerated lesion on the anterior suburethral vagina, just left of the midline measuring 4 × 2cm. Initially, this mass was considered to be a vaginal cancer. Intraoperative diagnosis of a benign urethral diverticulum was made.ConclusionsThe diagnosis of urethral diverticula based on the vast array of presenting symptoms, is difficult. This original case report may benefit both gynecologic oncologists and female pelvic surgeons and reconstructive surgeons to keep urethral diverticulum in the differential diagnosis when faced with a bleeding midline anterior vaginal mass. This unusual presentation of a urethral diverticulum demonstrates how similarly it may present to a vaginal cancerous mass.

Diagnosis of female urethral diverticulum using transvaginal contrast-enhanced sonourethrography

This study investigated the value of transvaginal contrast-enhanced sonourethrography for the diagnosis of female urethral diverticulum (UD) by comparing results of contrast-enhanced ultrasound images and surgical findings. A total of 14 female UD patients underwent preoperative transvaginal contrast-enhanced sonourethrography between July 2010 and June 2012. History and physical examination were initially assessed by the same urologist. Transvaginal contrast-enhanced ultrasound imaging was performed and interpreted by the same ultrasonographer. Definite diagnosis was made by tracking the flow of the microbubbles into the cyst. Additionally, sagittal, cross-sectional, and dynamic images were obtained, and color Doppler ultrasound was applied in all cases. Data on the size, location, configuration, and opening of the UD was documented, and then compared with the surgical findings. The most common symptoms presenting in the UD patients included urinary incontinence (71.5 %), recurrent urinary tract infection (57.1 %), frequency (50 %), urgency (35.7 %), dysuria (35.7 %), and dyspareunia (21.4 %). On physical examination, 8 out of 14 patients (57.1 %) had a palpable anterior vaginal wall mass, while 6 out of 14 patients (42.9 %) had no palpable mass. Transvaginal contrast-enhanced sonourethrography revealed 17 diverticula orifices in total and correlated well with surgical findings regarding the size, location, configuration, and the opening of the UD. In patients with chronic irritative bladder symptoms, but with no response to conventional treatment a high index of suspicion for UD should be maintained. Our study demonstrates that transvaginal contrast-enhanced sonourethrography is a useful tool for defining the size, location, configuration, and opening of the UD before surgery.