Perineal leiomyoma in a postmenopausal woman: A case report

Abstract

Abstract. Leiomyomas in the female reproductive system are commonly located in the uterus and typically regress following the menopause. Vulval leiomyomas are rare, and to the best of our knowledge, perineal leiomyomas in postmenopausal women have not been previously reported in the literature. The present case describes a 60-year-old Chinese woman who experienced perineal tenderness and lumbosacral radiating pain. The patient, who went through the menopause 12 years previously, had presented with a painful perineal mass for 1 year, which was subsequently diagnosed as a postmenopausal perineal leiomyoma. The mass was locally resected, and histopathological examination of the lesion resulted in a diagnosis of benign epithelioid leiomyoma. Immunohistochemical staining identified that the leiomyoma was positive for estrogen receptor and negative for progesterone receptor expression. The patient was followed up for 1 year and did not experience any pain or recurrence. The symptoms of local and lumbosacral radiating pain are extremely rare and may be induced by peripheral nerve stimulation. The etiology of postmenopausal perineal leiomyoma may be associated with infection, dietary, stress and environmental factors, and the role of estrogen cannot be overemphasized in cases of postmenopausal leiomyoma.

Vulvar leiomyoma in a postmenopausal woman

“…The patient was a woman in her 60s who was seen and treated at the Department of Gynecology, First Affiliated Hospital, Xi'an Jiaotong University (Xi'an, China). Unlike the patient in our case report, this patient had no history of hormone replacement treatment 5…”

“…Leiomyomas originating in the vulva are much rarer, with only a few hundred cases found in the medical literature. Just as leiomyomas of the uterus are less common in postmenopausal women, vulvar leiomyomas are less common in postmenopausal women with only one other case report in literature to our knowledge 5. The patient was a woman in her 60s who was seen and treated at the Department of Gynecology, First Affiliated Hospital, Xi'an Jiaotong University (Xi'an, China).…”

Leiomyoma of levator ani muscle

“…Later, when they reach significant sizes, there are usually symptoms of compression such as anal and perineal pain, alterations in intestinal transit, itching, rectal bleeding, tenesmus, voiding syndrome, dyspareunia, are some of the most frequent symptoms for which the patient consults. 2,5 The diagnosis can be made from the pelvic examination or with some image testing such as ultrasound, urethrocystography, urethrocystoscopy, tomography or magnetic resonance. 6 Ultrasound, tomography and magnetic resonance images resemble those of cervical myoma.…”

Recurrent leiomyoma of the vulva mimicking peripheral nerve sheath tumour

“…Leiomyomas of the perineal region, similar to uterine leiomyomas, are thought to shrink in size/regress after menopause 8. However, few reports suggest that they can recur in the postmenopausal women and can even grow in size in that group, suggesting mechanism other than hormonal in their development 8 9. This includes abnormal tissue repair resulting in altered extracellular matrix formation and disordered healing, and a reduced apoptosis secondary to injury from infection/inflammation 10.…”