Zemni Ines, Aloui Marwa, Saadallah Fatma, Mansouri Houyem, Chargui Riadh, Ben Dhiab Tarek
Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University Tunis EL Manar, Tunisia.
Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University Tunis EL Manar, Tunisia.
Int J Surg Case Rep. 2023 May;106:108139. doi: 10.1016/j.ijscr.2023.108139. Epub 2023 Apr 7.
Uterine leiomyoma is the most common pelvic tumor in women. Its cervical location is rare and may extend into the vagina in 2.5 % of cases. Treatment of cervical fibroids includes either myomectomy or hysterectomy, depending on the patient's profile and the tumor's characteristics. These fibroids challenge the surgeon because of their proximity to vital pelvic structures and their likelihood of causing surgical complications.
A 47-year-old woman presented with abdominopelvic pain and a bulky necrotic mass protruding out of her vagina. CT scan showed a large heterogeneous anterior mass of the cervix measuring 30 cm prolapsed in the vagina. She underwent a total hysterectomy with complete resection of the cervical mass. The histopathological report confirmed the diagnosis of a cervical leiomyoma with no signs of malignancy.
Three types of cervical leiomyoma are known: interstitial, supra-vaginal, and polypoidal. The last one, observed in our case, is the rarest type. When prolapsed in the vagina, cervical leiomyoma can outgrow its blood supply and become necrotic. Several approaches are available for the management of cervical leiomyomas. The approach choice depends on many factors such as the tumor size and location, its extent, and the desire for fertility.
This report describes the case of a large gangrenous and prolapsed non-pedunculated cervical leiomyoma which remains a rare and disabling complication of this benign tumor for which hysterectomy remains the treatment of choice.
子宫平滑肌瘤是女性最常见的盆腔肿瘤。其宫颈部位的肌瘤较为罕见，2.5%的病例中肌瘤可延伸至阴道。宫颈肌瘤的治疗包括肌瘤切除术或子宫切除术，具体取决于患者情况和肿瘤特征。这些肌瘤因靠近盆腔重要结构且可能引发手术并发症，给外科医生带来挑战。
一名47岁女性因腹盆腔疼痛及阴道内突出的巨大坏死肿物就诊。CT扫描显示宫颈前方有一大小为30 cm的巨大不均质肿物脱垂至阴道。她接受了全子宫切除术及宫颈肿物的完整切除。组织病理学报告确诊为宫颈平滑肌瘤，无恶性征象。
已知宫颈平滑肌瘤有三种类型：间质型、阴道上部型和息肉样型。我们病例中观察到的息肉样型是最罕见的类型。当宫颈平滑肌瘤脱垂至阴道时，其生长可能超过血供并发生坏死。宫颈平滑肌瘤的治疗有多种方法。治疗方法的选择取决于许多因素，如肿瘤大小和位置、范围以及生育需求。
本报告描述了一例巨大坏疽性脱垂的无蒂宫颈平滑肌瘤病例，这仍是这种良性肿瘤罕见且致残的并发症，子宫切除术仍是首选治疗方法。
