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

Abstract

Leiomyoma is a benign mass of smooth muscle cells that most frequently occurs in the gastrointestinal and genitourinary system. However, leiomyomas arising from the female urethra, especially paraurethral, are exceedingly rare. We present a case of a true paraurethral leiomyoma. The initial presenting complaints were dyspareunia, increased urinary frequency, and a 1.8 cm lesion in the anterolateral wall of the vagina that was suspicions of a Gartner's duct cyst. However, the patient was lost to followup for 5 years. On return, the patient continued to complain of dyspareunia, urinary frequency, suprapubic pain, and dysuria. The patient was treated for multiple instances of urinary tract infections (UTIs) without symptomatic improvement. A pelvic MRI demonstrated a 3.8 x 4.1 x 4.7 cm mass within the left anterior aspect of the lower cervix/vagina. Cystoscopy was notable for an unremarkable urethra with an anterior vaginal wall mass extrinsically pushing the bladder trigone without penetration into the bladder mucosa or communication with the ureter or vagina. A biopsy from the paraurethral mass revealed well-delineated cells with low mitotic figures encompassed in a fibrous capsule non-adherent to adjacent structures. The mass was subsequently excised through the anterior vaginal wall with no complications and complete resolution of symptoms.

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

“…A voiding cystourethrogram is helpful for evaluating an urethral lesion and any other lesion that might arise from it, or a from a diverticulum, as well as any possible communication of a paraurethral lesion with the urethra. 7 Magnetic resonance imaging shows a signal intensity in T1-weighted sequences analogous to that of pelvis muscle, while, in T2 sequences, there is an intensity similar to fat (i.e., referring to a solid mass). 6 In a case presenting with lower urinary-tract symptoms, a visualized urodynamic study and a biopsy were obtained prior to excision because of a suspected malignancy.…”

“…6 In a case presenting with lower urinary-tract symptoms, a visualized urodynamic study and a biopsy were obtained prior to excision because of a suspected malignancy. 7 Diagnostic cystourethroscopy remains a cornerstone for differentiating such cases, especially for differentiating urethral leiomyomas from paraurethral leiomyomas.…”

Leiomioma parauretral: manifestación clínica inusual, primer reporte de caso en literatura colombiana

“…El leiomioma es una causa poco frecuente de masa parauretral, se deben tener en cuenta los posibles diagnósticos diferenciales para su correcto manejo 6,13,[24][25][26] . En una de las series más grande de Blaivas y colaboradores de 79 mujeres con masas periuretrales, la principal causa fue el divertículo uretral con 84% de los casos, seguido del quiste de la pared vaginal con 6% de casos y el leiomioma con 5% de casos.…”

“…La distinción entre leiomioma uretral, parauretral y de pared vaginal anterior puede ser muy difícil debido a su proximidad anatómica 17,[25][26][27] , por lo que adicional a un examen físico detallado se puede complementar con ayudas diagnósticas imagenológicas. Algunas diferencias entre leiomioma uretral y parauretral son que los segundos son más móviles y en la cirugía generalmente respetan la uretra y no se requiere reparo adicional 7,[22][23][24][25] ; en el presente caso la ecografía tenía muchas limitaciones en el reporte, pues no tenía muchas especificaciones, además la paciente no requirió sutura uretral.…”

“…No hay guías, ni protocolos para establecer su diagnóstico, toda la información se basa en series y reportes de casos. Es importante una adecuada anamnesis, un examen físico con una masa no dolorosa, regular y el complemento de una uretrocistoscopia y/o imágenes para descartar sus posibles diagnósticos diferenciales 7,15,19,24 . Sin embargo, solo con la patología se confirma el diagnóstico definitivo 12,28,29 .…”