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Posthysterectomy vault eversion with a large retroperitoneal mass.

V L Handa1, K Jain, K McCue

  • 1University of California Davis School of Medicine, Sacramento, USA. vlhanda@ucdavis.edu

International Urogynecology Journal and Pelvic Floor Dysfunction
|September 25, 2001
PubMed
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A large pelvic neurofibroma was initially masked by complete vaginal eversion in a posthysterectomy patient. Advanced imaging like CT and MRI were crucial for diagnosing this rare pelvic mass.

Area of Science:

  • Gynecologic Oncology
  • Surgical Pathology
  • Radiology

Background:

  • Pelvic masses can present with diverse symptoms, sometimes mimicking or obscuring other conditions.
  • Vaginal eversion, a complication post-hysterectomy, typically presents with pelvic organ prolapse.
  • Neurofibromas are benign tumors of nerve sheath cells, rarely presenting as large pelvic masses.

Observation:

  • A 66-year-old woman with posthysterectomy vaginal eversion reported persistent pelvic fullness despite pessary use for prolapse.
  • Physical examination failed to detect a pelvic mass, highlighting a diagnostic challenge.
  • Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 9 cm tumor in the rectovaginal septum extending to the presacral space.

Findings:

  • Laparotomy confirmed a massive neurofibroma originating from the anterior rectal wall.

Related Experiment Videos

  • The complete vaginal prolapse significantly obscured the clinical presentation of the large pelvic tumor.
  • CT and MRI proved invaluable in accurately identifying and characterizing the pelvic neurofibroma.

    • Implications:

    • This case underscores the importance of advanced imaging in diagnosing pelvic masses when physical examination is inconclusive.
    • It highlights a rare instance where vaginal prolapse masked a large pelvic neurofibroma, challenging conventional diagnostic approaches.
    • The successful diagnosis and characterization of this rare pelvic mass using CT and MRI offer insights for similar complex cases.