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Singh A et al., J Womens Health, Issues Care 2015, 4:1
http://dx.doi.org/10.4172/2325-9795.1000175
Journal of Women’s
Health, Issues & Care
Case Report
A SCITECHNOL JOURNAL
Cervical Myomatous Polyp
Leading to Third Degree Uterine
Prolapse in Virgin Lady with Intact
Hymen
Nilanchali Singh1, Kuan-Gen Huang2* and Tida Kijjadip3
1Department of Obstetrics and Gynaecology, University College of Medical
Sciences, New Delhi,
India
2Department of Obstetrics and Gynaecology, Chang Gung Memorial University
College & Hospital, Taiwan
3Women’s
Health Center, Samitivej Sukhumvit Hospital, Bangkok, Thailand
discharge. There was no history of urinary urgency, frequency,
nocturia or stress incontinence. She had no menstrual complaints. She
denied any history of sexual contact.
The general physical and systemic examinations were normal.
Abdominal examination did not reveal any organomegaly or any mass.
When examined locally, the hymenal ring was found to be intact and
the cervix was protruding out of the hymenal ring. There was a 6 x 4
cm sized, irregular, firm, polypoidal mass arising from the cervix at 4
o’clock position. The polyp had surface erosions. The consistency and
appearance were suggestive of fibroid polyp. Along with the fibroid
polyp, there were few ectocervical and endocervical polyps. There was
no evidence of cystocele or rectocele on local examination (Figure 1).
Pelvic examination was not performed and she refused rectal
examination.
*Corresponding author: Kuan-Gen Huang, MD, Department of Obstetrics and
Gynaecology, Chang Gung Memorial University College & Hospital, Linkou, 5, FuHsin Street, Kueishan, Taoyuan, Taiwan 333, Tel: +886-3-3281200 ext 8253; Fax:
+886-3-328-6700; Email: [email protected]
Rec date: July 28, 2014, Acc date: Dec 30, 2015, Pub date: Jan 05, 2015
Abstract
We are reporting a rare case of cervical myomatous polyp
leading to third degree utero-vaginal prolapsed in a 40 years
old virgin lady with intact hymenal ring. Vaginal myomectomy
was performed and the prolapse reduced gradually and
spontaneously within a span of three months. The hymen
remained intact after the procedure. There are reports of
prolapse occurring due to cervical myoma in multiparous
women but no such case in a virgin has been reported
according to our knowledge after extensive search in Pubmed
and Google. Such cases require conservative surgical
approach as the tone of the tissues may suffice for reverting
back the prolapse.
Keywords: Cervical; Myomatous
Prolapse; Virgin, Intact Hymen
Polyp;
Utero-Vaginal
Introduction
Leiomyomas are common uterine tumors and can occur anywhere
in the uterus. Cervical leiomyomas are rare and usually occur in
supravaginal portion. Occurrence in portiovaginalis is uncommon [1].
Large cervical leiomyomas can lead to uterine prolapse due to the
tractional force exerted by them. There are only few reports of such
pathology in literature, but, despite extensive search, we could not find
a report of prolapse due to cervical leiomyoma in a virgin with intact
hymenal ring [1-3]. The rarity of this case as well as the excellent
results after minimal surgical intervention, lead us to report this case.
Case Report
A 40 year old, unmarried, nulliparous woman presented to the
gynaecology clinic with complaints of mass protruding out per
vaginum for last one year. Initially, the mass was reducible and
protruded only while standing or walking but since last few months, it
was persistently exposed. She also complained of abnormal vaginal
Figure 1: Showing the cervical myoma and endocervical polyp
along with the third degree utero-vaginal prolapse
The routine blood and urine investigations were normal. An
ultrasonography was performed which revealed otherwise, normal
uterus and adnexa. Management of the prolapse was unclear since the
patient was a virgin. Considering the cervical fibroid to be the sole
cause of prolapse, complete excision of the fibroid polyp was planned.
Prior biopsy was not performed as there were no features of
malignancy. The patient was counseled regarding the treatment and
she was admitted. Thereafter, vaginal myomectomy along with
polypectomy was performed. After the procedure, the cervix remained
2 cm outside the introitus (Figure 2).
She was discharged on third post-operative day and was advised
Kegel’s exercise at home. The histopathology confirmed the diagnosis
of leiomyoma. During her follow-up, we could appreciate the gradual
reduction in the uterine prolapse. At her follow-up after three months
of surgery, the patient was completely asymptomatic without any
clinical evidence of prolapse.
All articles published in Journal of Women’s Health, Issues & Care are the property of SciTechnol, and is protected by
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Citation:
Singh A, Huang KG, Kijjadip T (2015) Cervical Myomatous Polyp Leading to Third Degree Uterine Prolapse in Virgin Lady with Intact Hymen. J
Womens Health, Issues Care 4:1.
doi:http://dx.doi.org/10.4172/2325-9795.1000175
infected and even gangrenous as reported by Palamchamy et al., [4]
Good antibiotic therapy should precede the surgical treatment in such
cases.
Figure 2: Showing the gradually decreasing prolapse after surgery.
Intact hymenal ring can be appreciated.
Discussion
Cervical leiomyomas are rare tumors and have some unique
complications apart from those in common with leiomyomas located
elsewhere. They can lead to infections, ulcerations over the myoma,
gangrenous changes, obstetric complications like cervical
incompetence and obstructed labor and sometimes, utero-vaginal
prolapse as seen in our case [4,5]. Oruc et al., reported a case of
prolapsed, pedunculated cervical myoma causing complete
obstruction of the vagina in a pregnant woman [5]. She developed
preterm premature rupture of membranes and fetal demise for which
abdominal hysterectomy had to be performed since vaginal approach
was not possible. There are some reported cases of prolapse or even
procidentia due to large cervical leiomyoma, most of them being in
multipara. Suneja et al., reported a case of incarcerated procidentia due
to cervical fibroid [3]. Gurung et al., reported a case cervical
elongation and third degree utero-vaginal prolapse due to huge,
compressed, pedunculated fibromyoma of the cervix [1]. Baum et al.,
also reported a similar case [2]. There are also few reports of giant
cervical polyps protruding out of the introitus in nullipara and even in
virgin women [6] but we could not find a case of cervical myoma
leading to prolapse in such women in the literature.
Large fibroid polyps with prolapse can be mistaken for uterine
inversion or even malignancy, as reported by some authors [4,7].
Biopsy may not be necessary and excision can be performed as only
2% of cervical polyps are malignant [7]. Treatment of the condition
depends on other associated factors like age, parity, associated
comorbid conditions etc. It is preferable to perform a total
hysterectomy in older women with completed family if associated with
multiple uterine leiomyomas [7]. At times, the fibroid polyp may get
Volume 4 • Issue 1 • 1000175
The mechanism of prolapse in cervical leiomyomais the constant
dragging force applied by the myoma on the uterus. The reported
cases are mostly in multipara with relatively weakened tone of the
tissues. Hence, both the factors lead to uterine prolapse; requiring both
myomectomy and prolapse repair for treatment, unlike our case. Our
patient was a nullipara with presumably, good tone of tissues. The only
factor leading to the prolapse was the pedunculated myoma in
portiovaginalis. Considering this fact, we only performed
myomectomy, without any measures for prolapse repair. We expected
the normal tone of tissues to revert the prolapse in due course and to
our content, the prolapse disappeared completely within three months.
Even the hymen could be preserved; fulfilling patient’s desire.
Recurrence can be prevented by early detection and treatment of cases
of cervical myoma before they cause pressure leading to prolapse.
Cervical myomas can be a cause of prolapse in nulliparous women
with otherwise, good tissue tone. We, therefore, recommend that in
cases of pelvic organ prolapse due to cervical myomas, a less aggressive
surgical approach can be tried. The tone of tissues along with, Kegel’s
exercise can lead to successful outcome as seen in this case.
References
1. Gurung G, Rana A, Magar DB (2003) Utero-vaginal prolapse due
to portio vaginal fibroma. See comment in PubMed Commons
below J ObstetGynaecol Res 29: 157-159.
2. Baum JD, Narinedhat R. (2009) Cervical myoma experienced as
prolapsed.J Minim Invasive Gynaecol 16: 248-249.
3. Suneja A, Taneja A, Guleria K, Yadav P, Agarwal N. (2003)
Incarcerated procidentia due to cervical fibroid: An unusual
presentation. Aust N Z J Obstet Gynaecol 43: 252-253.
4. Palanichamy G, Authilingom R (1976) Degenerating cervical
myoma simulating chronic puerperal inversion and gangrene of
uterus- (Report of a case). J ObstetGynaecol India 25: 790-791.
5. Oruç S, Karaer O, Kurtul O (2004) Coexistence of a prolapsed,
pedunculated cervical myoma and pregnancy complications: a
case report. See comment in PubMed Commons below J Reprod
Med 49: 575-577.
6. Khalil AM, Azar GB, Kasoar HG, Abu-Musa AA, Charara IR, et.al.
(1996) Giant cervical polyp: A case report. J Reprod Med 41:
619-621.
7. Abdul MA, Koledade AK, Madugu N. (2012) Giant cervical
complicating uterine fibroid and masquerading as cervical
malignancy. Arch IntSurg 2: 39-41.
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