Management of vaginal leiomyomas during pregnancy - A case report

Uterine fibroids (leiomyomas) are the most common benign tumors of the female genital tract, affecting about 20 % of women over 35 years of age. Although these tumors are common in the uterus, their occurrence in the vagina is extremely rare. Vaginal fibroids may present as a vaginal mass, often diagnosed at an advanced stage, as they can be mistaken for other benign conditions.

A 38-year-old patient, pregnant at 33 weeks, consulted for a vaginal mass and dyspareunia for two months. Physical examination revealed a smooth mass on the anterolateral vaginal wall. Ultrasound showed a prolapsed formation compatible with a vaginal leiomyoma. The tumor was surgically removed, and histopathological examination confirmed the diagnosis of benign leiomyoma. The patient gave birth vaginally at 39 weeks of pregnancy.

Vaginal leiomyomas are rare, often asymptomatic initially, but may cause pelvic pain, lower back pain, and obstruction of the vaginal passage during pregnancy. Their preoperative diagnosis is difficult, although MRI is more accurate than ultrasound. Treatment involves surgical excision, usually vaginally. Although leiomyomas are benign, postoperative monitoring is necessary to detect potential recurrences. These tumors are hormone-dependent and may regress after menopause.

Vaginal leiomyomas are extremely rare, making diagnosis and treatment complex due to limited case data and the complexity of vaginal anatomy. Surgical removal remains the standard treatment, with vigilant follow-up for recurrence.