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Uterine leiomyomas (LM) are tumors arising from the non-neoplastic proliferation of smooth muscle cells within the myometrium. Like benign tumors, LM are not generally spread through the lymphatic system, and therefore should not be associated with lymphadenopathy. Herein, we present a case of a 60-year-old female who presented to the clinic with postmenopausal bleeding in the setting of sonographically evident uterine LM and abdominal lymphadenopathy. A lymph node biopsy revealed plasma cells and an eosinophilic material presumptively diagnosed as amyloid. She then underwent an abdominal hysterectomy for definitive treatment of LM. Surgical pathology confirmed the clinical diagnosis of uterine and cervical leiomyoma. Current literature suggests that genetic and epigenetic abnormalities contribute to the pathogenesis of LM in addition to hormonal signals such as estrogen and progesterone. It is unusual for LM to occur in post-menopausal women due to reduced hormonal influence. Therefore, this case explored an alternative mechanism of tumor proliferation. This case hypothesizes that genetic mutations and epigenetic changes resulting from chronic inflammatory offenses contributed to LM growth and lymphadenopathy.

Solitary plasmacytoma (SP) is a malignant tumor caused by the monoclonal proliferation of plasma cells, representing less than 5% of plasma cell tumors. SP can be categorized into two groups: solitary bone plasmacytoma (SBP) and solitary extramedullary plasmacytoma (SEP). SEP most commonly occurs in the head and neck and is rarely located in the reproductive system. Here, we report a case of a 77-year-old woman with SEP in the cervix who had a 7-day history of vaginal bleeding. Ultrasonography and magnetic resonance imaging (MRI) showed an oval mass in the cervix, which was initially considered as neoplastic lesions and highly suspected to be cervical cancer, but cervical leiomyoma and other benign tumors cannot be completely excluded. Subsequently, cervical biopsy showed that the tumor was SEP, and then the patient underwent surgery. The postoperative pathological diagnosis was also SEP, which confirmed the radiologist’s misjudgment. In conclusion, SEP that occurs in the cervix is remarkably rare, and only nine cases have been reported in the cervix. No case reports to date have described in detail the imaging findings of cervical SEP. This study demonstrates the MRI imaging characteristics of a patient with SEP of the cervix and reviews the imaging findings of SEP reported in the previous literature, in order to provide more extensive insights for radiologists to consider the differential diagnosis of cervical lesions.

Study Objective To present a rare case of cervical leiomyoma in a post partial hysterectomy patient. Design Case report illustrated with video. Setting Under general anesthesia, the patient was placed in dorsolithotomy position, arms alongside the body and legs 80°abducted in adjustable stirrups. Two robotic portals were positioned in both iliac fossae, in addition to the umbilical, and a conventional laparoscopic portal was placed on the right flank. The cervix was manipulated and delineated with a 60cc syringe. Patients or Participants We present a case of a 43-year-old woman who had undergone partial hysterectomy 8 years ago due to intense menstrual bleeding and multiple uterine fibroids. She went to the gynecologist with a complaint of deep dyspareunia and chronic pelvic pain in the left lower quadrant. These complaints started after 3 years of hysterectomy and were now more intense. Physical examination revealed the presence of a partially mobile nodule of 5cm in left iliac fossa, slightly sore to the touch. During the investigation, her pelvic MRI showed signs of partial hysterectomy, the uterine cervix with multiple retention cysts and a well-defined nodule with low T2 signal in the left lateral region vascularized by branches from the left internal iliac vessels measuring 5.3 × 4.2 × 4.7 cm. Cervical cytology was negative. Interventions Patient was eligible for a robotic-assisted simple trachelectomy. Measurements and Main Results Surgery duration time was 2 hours with minimal blood loss. She was discharged after 15 hours with mild soreness. After 2 weeks she had complete remission of symptoms and the final pathological report confirmed leiomyoma of the uterine cervix. Conclusion Partial hysterectomy may not be enough for uterine fibroid treatment once the uterine cervix can be a site of fibroid growth. In addition, surgery afterwards may be hampered by the presence of pelvic adhesions and anatomical distortion.

Background and objectives: Cervical leiomyomas are a rare benign disease. Although they are mainly treated surgically, currently, there is not a standardized treatment for cervical leiomyomas. This study aims to summarize current literature evidence about treatment options for cervical leiomyomas. Materials and methods: A systematic research of the literature was conducted in Scopus, PubMed/MEDLINE, ScienceDirect, and the Cochrane Library, including observational prospective and retrospective studies, case series and case reports. We collected data regarding studies related to treatment options for cervical leiomyomas, evaluating the following aspects: study design, population, treatment type, rate of surgical complications, and fertility outcome. Results: According to literature research, 38 articles were included. Among 214 patients, the weighted average age was 39.4 years-old; 23 patients were pregnant. Most of the leiomyomas (78%) were extracervical; in 22% of cases (29 patients) were intracervical; 188 patients (88%) received surgical treatment, 6 (3%) received exclusive conservative management and 21 (10%) underwent interventional radiology treatment. One hundred twenty-seven patients (67.5%) underwent myomectomy, while 54 (28.7%) and 7 (3.7%) hysterectomy and trachelectomy, respectively. Cervical myomectomy was performed by open surgery in 21 out of 127 cases (16.5%), while in 92 (72.4%) and 6 (4.7%) patients the surgical approach was performed by traditional and robot-assisted laparoscopy, respectively. The total rate of surgical complications was 5.6%. Conclusion: Surgery is the primary therapeutic option for cervical leiomyomas with a low rate of surgical complications. Interventional radiology techniques have reported promising but still limited results.

The prevalence of clinically symptomatic cervical leiomyomas in pregnancy is lower than 0.1%. Surgical intervention is necessary in extremely rare cases and only few are described in the literature. This study presents a case of successful vaginal myomectomy in the 13 th week of pregnancy followed by a delivery of a healthy neonate in term by cesarean section.

A 13-year-old male presents for evaluation of a right-sided posterolateral neck mass, first noted four years prior to presentation; incisional biopsy two years ago suggested a benign lymph node. Recent growth and increased pain prompted referral to our tertiary care center. MR imaging revealed a densely calcified mass in the right posterior paraspinous muscles with intense enhancement with gadolinium contrast, approximately 5 cm × 2.8 cm x 4.6 cm. Incisional biopsy showed leiomyoma with extensive dystrophic calcifications. This case describes a rare finding of extraesophageal leiomyoma of the neck; this is only the second such case reported in a pediatric patient.

Study Objective To describe and demonstrate surgical pearls for complete laparoscopic excision of a cervical leiomyoma. Design Video presentation of a clinical case with imaging, surgical procedure, and key teaching points. Setting Academic Institution. Patients or Participants 33-year old G0 woman with a 4 year history of infertility and abnormal uterine bleeding refractory to hormonal agents. Interventions The patient underwent a diagnostic hysteroscopy, laparoscopic myomectomy, and chromopertubation. Measurements and Main Results Surgical recommendations for safe and effective laparoscopic resection of cervical myomas include dissection of the bladder using a lateral to medial approach, backfilling of the bladder when necessary to avoid injury, and taking care to avoid entry into the cervical canal while achieving complete excision. A pediatric Foley catheter can function as stent to post-operative cervical stenosis. Additional techniques for hemostasis in this type of complex surgery are also reviewed. Retroperitoneal isolation of the uterine arteries and the use of laparoscopic bulldog clamps may be necessary for larger myomas. Conclusion Complete laparoscopic resection of cervical myomas can be performed safely and effectively with preservation of the uterus for future fertility. Several techniques reviewed in this video may be useful to reduce surgical morbidity and allow a minimally invasive approach.

Video Objective Uterine leiomyosarcoma (uLMS) is aggressive mesenchymal neoplasm and is associated with a high risk of recurrence and poor prognosis. The 5year overall survival rate is about 60% even in FIGO stage I disease. There is no firm evidence of chemotherapy, so surgical resection should be considered to control the disease in case of localized recurrence. We will report a case underwent total laparoscopic complete resection for recurrent mass involved sigmoid colon and right ureter. Setting Gynecology and Obstetrics department of a general hospital. Interventions The patient was a 56-year-old woman underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy for enlarged 9cm cervical leiomyoma. The pathological examination of the uterus resected showed cytologic atypia,nuclear mitoses and coagulative necrosis, she was diagnosed as primary uLMS, stageⅠB. She rejected to receive adjuvant chemotherapy. After 7months, the isolated metastasis in pelvic and lung was suspected. Magnetic resonance imaging revealed that the 4cm tumor possibly be involved sigmoid colon and right lower ureter. Resection of the recurrent mass with segmental bowel resection and partial resection of ureter with ureteroneocystotomy was performed laparoscopically without any complications. Complete tumor resection with histologic negative margins was achieved. She had postoperative adjuvant chemotherapy with doxorubicinfor 6 cycles and additional surgery for lung meta is scheduled. Also, we experienced another three salvage cases with successful resection in combination with laparoscope and thoracoscope. Conclusion The surgical indications for recurrent uLMS should be selected, but the complete resection of localized recurrence may lead to control the disease. Minimally invasive approach may be one of the feasibleoption.

Purpose To compare the diagnostic accuracy of routine magnetic resonance imaging (MRI) (T1WI and T2WI), diffusion-weighted MRI (DWI), and DCE-MRI (dynamic contrast-enhanced MRI) at 3.0T for differentiation of cervical cancer and benign cervical lesions. Materials and Methods A cohort of 75 cervical cancer patients, 26 cervical leiomyoma patients, 22 patients with cervical polyps consecutively underwent pelvic MRI scanning on a 3T MR unit. Two radiologists independently evaluated images at three imaging settings; routine MRI alone, DWI combined with routine MRI (DWI+routine MRI), and DCE-MRI. The apparent diffusion coefficients (ADCs) were calculated from b 0, 600 s/mm2 and b 0, 1000 s/mm2. Results DWI+routine MRI was significantly better than routine MRI and obtained high accuracy (0.95); the diagnostic performance was not significantly different between DWI+routine MRI and DCE-MRI. Reader agreement was excellent for both DWI+routine MRI (κ, 0.90) and DCE-MRI (κ, 0.92). The ADCs of cervical cancer were significantly lower than those of benign cervical lesions at both ADC maps (P = 0.0001). The diagnostic accuracy was not different at both ADC maps (P = 0.375). Conclusion For differentiation of cervical cancer and benign cervical lesions, unenhanced MRI with combined diffusion-weighted and routine MRI (DWI+routine MRI) at 3T can provide accurate information and may be preferable to DCE. J. Magn. Reson. Imaging 2015. J. Magn. Reson. Imaging 2015;42:1094–1099.

Cervical leiomyoma consists 1-2% of all leiomyoma and myxoid degeneration of cervical fibroid is very rare. We present an old neglected case of huge necrotic cervical leiomyoma presenting with prolapse of mass and pelvic organs in a woman with multiple co-morbidities. Early management was necessary for improving her quality of life and controlling blood sugar. In lack of fitness for anaesthesia we performed her vaginal myomectomy under Intravenous Sedation. Prolapse was reducible and in absence of septic foci blood sugar profile improved. Vaginal myomectomy is a safe and quick procedure with least surgical morbidity and should be considered in cervical fibroids.

Since its introduction in 1995, uterine artery embolization (UAE) has become an established option for the treatment of leiomyomas. Identification of a leiomyoma using arteriography improves the ability to perform effective UAE. UAE is not contraindicated in a pedunculated subserosal leiomyoma. UAE in a cervical leiomyoma remains a challenging procedure. A leiomyoma with high signal intensity on T2-weighted imaging responds well to UAE, but a malignancy with similar radiological features should not be misdiagnosed as a leiomyoma. Administration of gonadotropin-releasing hormone agonists before UAE is useful in selected patients and is not a contraindication for the procedure. The risk of subsequent re-intervention 5 years after UAE is approximately 10%, which represents an acceptable profile. UAE for adenomyosis is challenging; initial embolization using small particles can achieve better success than that by using larger particles. An intravenous injection of dexamethasone prior to UAE, followed by a patient-controlled analgesia pump and intra-arterial administration of lidocaine after the procedure, are useful techniques to control pain. Dexmedetomidine is an excellent supplemental sedative, showing a fentanyl-sparing effect without causing respiratory depression. UAE for symptomatic leiomyoma is safe and can be an alternative to surgery in most patients with a low risk of re-intervention.

Leiomyomas are most common uterine and pelvic tumours. The most common anatomical location is uterus. Fibroids arising from cervix are rare tumours accounting for 2% of all fibroids. A cervical leiomyoma is commonly single and is either interstitial or subserous, rarely it becomes submucous and polypoidal. Here authors report a case of huge cervical fibroid in an unmarried lady who presented to us with complaint of heaviness in abdomen. On per abdomen examination a firm mass of 32 weeks size arising from pelvis with restricted mobility was noticed. Ultrasound showed 21*10.3*10 cm heterogenous mass in pelvis with evidence of internal vascularity. MRI was suggestive of fibroid arising from body of uterus. True cut biopsy of the lesion was taken which showed benign lesion. Decision for myomectomy or Hysterectomy (according to intraoperative findings) was taken. While doing the procedure, after accidental ligation of left ureter and injury to bladder, diagnosis of cervical fibroid was made. Hence pre-operative diagnosis of cervical fibroid is very important in order to avoid damage to bladder and ureters.

Rationale: As more and more women delay their child bearing age, the prevalence of uterine fibroids during pregnancy is likely to increase. Patient Concerns & Lessons: We report a Chinese Tibetan case with spontaneous expulsion of a huge cervical myoma after cesarean. Decreased blood supply of the myoma and the uterine contraction may contribute to the spontaneous expulsion. Vaginal-myomectomy is recommended as the initial treatment.

Thickening of the uterine cervix and bilateral ovarian cystic change was identified in a 6-month-old pig during routine abattoir inspection. Microscopically, the cervical lesion comprised a non-encapsulated mass of densely packed, large and monomorphic spindle cells within the myometrium. Immunohistochemically, the majority of these neoplastic cells expressed the cytoplasmic terminal smooth muscle differentiation marker calponin, the nuclear oestrogen receptor alpha and the progesterone receptor. The ovarian cysts were classified as follicular cysts. A diagnosis of leiomyoma of the uterine cervix with bilateral ovarian follicular cysts was made. The expression of calponin as a marker of smooth muscle differentiation in tumours of the genital tract of the pig has not previously been reported. The expression of steroid hormone receptors suggests a role for steroid hormones derived from the ovarian follicular cysts in tumourigenesis.

It is report and describes the development of clinical case of a dog of mixed breed of 10-year-old, who presented the protrusion of part of genital tissue, with bloody discharge decreased, smooth texture, edemetizada without the presence of tenderness, this picture was accompanied by the beginning of the reproductive stage (oestrus). Besides this, the patient had the presence of masses in breast area, according to anamnesis were from about 12 months. Made physical patient assessment, basic tests such as blood count, blood chemistry (ALT, BUN and creatinine) and complementary as histopathology are performed. As treatment of these pathologies a surgical approach is performed, in order to remove the protruded tissue, neoplastic tissue and breast ovariohysterectomy, choosing to complete reproductive apparatus corresponding histopathology to distinguish the source or type of neoplasia (benign or malignant). After interpreted the histopathology, the result was related to: cervical leiomyoma, cysts of Naboth, bilateral follicular cysts and cyst paratubario side unspecified, which are tumors formed from mesothelial tissue, with benign type and resolved simply by the performing surgical procedure named above. After treatment, the patient had a good recovery, besides not having recurrence of these diseases.

INTRODUCTION Inversion of the uterus is an extremely rare complication of the non-puerperal period and is commonly caused by benign submucous, especially fundal, leiomyomas. A case of a totally inverted cervix due to a prolapsed huge cervical leiomyoma mimicking chronic non-puerperal uterine inversion in a perimenopausal woman is presented. PRESENTATION OF CASE A 52-year-old perimenopausal woman was admitted to our clinic with an ulcerated, necrotic, infected and swollen prolapsed mass. Gynecologic history revealed that she was advised myomectomy because of her cervical myoma 2 years ago but she refused to have an operation as she believed that her positive thoughts would shrink the myoma. Presumed diagnosis before surgery was chronic non-puerperal uterine inversion. An intraoperative diagnosis was totally inverted cervix due to a huge cervical leiomyoma. Vaginal hysterectomy without adnexectomy, was performed. CONCLUSION This is the first case in the literature which a totally inverted cervix due to a prolapsed huge cervical leiomyoma. Cervical fibroids can grow in perimenopausal period and in extremely rare cases can cause total cervical inversion. © 2014 The Authors.

We present two case studies: an unusually sited isthmicocervical leiomyoma and a huge prolapsed pedunculated submucous leiomyoma of the uterus. Case 1 was a 25-year-old virginal woman with a diagnosis of cervical leiomyoma with symptoms of anemia and menorrhagia. Magnetic resonance imaging revealed a mass impinging on the bladder and rectum. Myomectomy was the selected operation because of the patient’s age and her desire to preserve fertility, even though the tumor’s size and location increased the risk of operative blood loss and would make the surgical procedure difficult to perform. The pathological specimen was benign. Case 2 was a 43-year-old patient with a chief complaint of difficulty in voiding plus severe vaginal bleeding. The gynecological examination revealed a necrotic mass that filled the vagina completely and stretched its walls. The sonographic findings were consistent with a pedunculated submucous leiomyoma. Total abdominal hysterectomy and bilateral salpingoophorectomy were performed. The histopathological evaluation was benign leiomyoma of the uterus. Cervical and pedunculated submucous leiomyomas are uncommon and represent a technicosurgical difficulty due to location and huge size. However, in order to regress the complications and improve the patient’s quality of life regarding desire to preserve fertility, conservative surgical regimens should be chosen.

Leiomyomas of the cervix are said to be uncommon. To establish their frequency, 661 consecutive total hysterectomy specimens were examined macroscopically and microscopically. Myometrial leiomyomas were present in 427 uteri (64.6%) but cervical leiomyoma were present in only 4 (0.6%). One of these was 6 mm in diameter and occurred in a uterus without fibroids elsewhere. Only two could have been considered clinically significant. An additional six cases showed submucous fibroids of the body of the uterus protruding as a polyp into the endocervical canal but these were not considered cervical leiomyomas. The conclusion of the study is that cervical leiomyomas are extremely uncommon.

We encountered a patient with primary cervical leiomyoma with remarkable calcification and ossification. A 68-year-old man presenting with induration and swelling of the left submandibular region was found to have nodular lesions with calcifications in the left submandibular region and the upper mediastinum on CT. Fine needle aspiration biopsies (FNAB) of the left submandibular lesion revealed no malignancy. Resection was performed for definitive diagnosis and treatment. The resected specimen contained a solid tumor, which was markedly calcified and ossified on the cut surface. Histopathological examination showed proliferating spindle cells in a tangled and crossed arrangement. Immunohistochemically, the spindle cells were stained intensely withα-SMA and h-caldesmon, consistent with smooth muscle cells. These findings led to a definitive diagnosis of leiomyoma with calcification and ossification. This is extremely rare and the preoperative differentiation from other tumors of the head and neck was very difficult. By resection of the submandibular tumor, both definitive diagnosis of leiomyoma by histopathological and immunohistochemical analyses and treatment could be carried out. However, as the tumor in the upper mediastinum was most likely to be leiomyoma with calcification, he did not wish to undergo its biopsy and resection immediately. We have continued the follow-up.

Background Cervical cancer on the mucosal surface of a pedunculated cervical leiomyoma has not been reported. Case A 54-year-old woman who had a bulky protruding cervical tumor with a history of a vaginal bleeding was diagnosed as having squamous cell cancer of the cervix. She received a total of 45 Gy (1.8 Gy daily using 15MV photons) external pelvic irradiation. However, on the follow-up MRI, the mass showed no response. The pedunculated exophytic mass was excised and the pathologic examination showed a leiomyoma covered by cervical stroma and squamous cell carcinoma. She then received additional intracavitary brachytherapy. Conclusion This is the first case reported in the literature of squamous cell carcinoma on the surface of peduculated cervical leiomyoma that presented as an exophytic cervical tumor.

We report a challenging case of a huge gangrenous prolapsed cervical leiomyoma in a multiparous HIV positive lady. A 37-year-old para 3 lady presented with a progressively increasing irreducible mass protruding out per vaginam, 3 months duration of heavy menses, and symptoms of a urinary tract infection. We performed a vaginal myomectomy and she did well postoperatively. A prolapsed gangrenous cervical leiomyoma is a rare condition with only a few cases reported in the literature. Vaginal myomectomy for this condition can be performed in experienced hands without difficulties.

In the present report we describe a case of cervical leiomyoma that was diagnosed at parturition in a Holstein cow. The tumor mass, which measured 25.5 cm x 21.5 cm x 14.5 cm in size and weighed 4.5 kg, was removed surgically. The tumor was solid, well circumscribed, whitish-pink colored, and encapsulated. The tumor was diagnosed as leiomyoma. The leiomyoma. had no adverse effects on pregnancy. This is the first report of a bovine cervical leiomyoma during parturition. (c) 2007 Elsevier B.V. All rights reserved.

Cervical myomas arise from the smooth muscle cells of the cervix accounting for 2% of all uterine leiomyomas. This is a case report of a 31-year-old lady who presented with a white, watery vaginal discharge, and a 6-hour history of protrusion per vaginam. Examination revealed a progressively increasing mass protruding per vaginam. She underwent a vaginal myomectomy, and a leiomyoma 13 × 12 × 7 cm with areas of necrosis was removed. She did well postoperatively. Vaginal myomectomy is an effective procedure for patients with huge leiomyomas.

A 30-year-old-woman presented with uterine leiomyoma and primary sterility. Abdominal myomectomy was performed; however, one cervical leiomyoma was not resected because of a risk of excessive blood loss. Two years after the procedure, a secondary myomectomy using preoperative adjuvant uterine artery embolization (UAE) was performed because of pronounced menorrhagia and her hope for bearing children. The patient's dysmenorrhea disappeared postoperatively and she conceived spontaneously 3 years after the secondary myomectomy. This case suggests that myomectomy using preadjuvant UAE may be an another approach for the treatment of leiomyoma in patients who wish bear children in the future.

Indications for total laparoscopic hysterectomy do not exist, and cases of huge leiomyomas or cervical leiomyomas are often excluded from these indications because of their difficulty. However, with appropriate technical training and the standardization of this operation procedure, the limit of the indications for total laparoscopic hysterectomy have been expanded. In this video, I will show my technical training method and our standardized procedure for TLH. We will aslo introduce two clinical TLH cases (case 1: 3100g huge leiomyoma, case 2: 1080g cervical leiomyoma) which are normally excluded from the indications.

Recently, a case of cervical cancer on the mucosal surface of a pedunculated cervical leiomyoma had been reported. We experienced a similar but distinct case of microinvasive squamous cell carcinoma on the mucosal surface of a pedunculated submucous leiomyoma. A 45-year-old Korean woman underwent type I hysterectomy for heavy bleeding from pedunculated submucous leiomyoma. Histopathological examination revealed that the leiomyoma of which mucosa was covered focally by microinvasive squamous cell carcinoma. During the management of pedunculated leiomyoma protruding through cervix, caution must be taken because of, although rare instance, a possible coexisting malignancy.

The leiomyoma of uterine body is the most common benign genital tumor in woman of reproductive age but occurs uncommonly in the uterine cervix. Cervical leiomyoma is rarely clinically significant except their complications including pressure effects on the bladder or ureter, degenerative phenomena and menorrhagia. Recently we experienced a case of leiomyoma arising in the endocervix and oncomitant menorrhagia, so we report this case with a brief review of literature.

Choriocarcinoma most commonly occurs within the uterine corpus. Just as placental implantation rarely occurs in the cervix, choriocarcinoma of the cervix is unusual. A case is presented of a 35-year old white woman, para 1-0-0-1 who had an uneventful term pregnancy 1 year prior to admission. She used an IUD and reported regular menses until 3 months prior to admission when she noted irregular bleeding. At initial examination a serum pregnancy test was positive, indicating a mass thought to be a cervical leiomyoma and bilateral cystic ovaries. Pathologic interpretation of an endocervical curettage was choriocarcinoma. At that point a hysterectomy was performed; there were no further complications and the patient subsequently received 3 additional courses of methotrexate. Cervical choriocarcionoma may develop from cervical metastases from a primary tumor in the corpus which later spontaneously regresses, malignant transformation of a cervical pregnancy, or transport of chorionic cells from a preceding pregnancy that undergo malignant transformations after a dormant period. In the nulliparous patient the conservation of reproductive function should be considered if possible.