Bilateral obstructive uropathy and severe renal dysfunction associated with large prolapsed pedunculated submucosal leiomyoma of the uterus misdiagnosed as an intracervical fibroid: Report of a very rare case and a mini‑review of the literature&nbsp;

Thanasa,Efthymia; Thanasa,Anna; Grapsidi,Vasiliki; Xydias,Emmanouil; Kamaretsos,Evangelos; Ziogas,Apostolos; Paraoulakis,Ioannis; Simopoulou,Evagelia; Mousia,Maria; Thanasas,Ioannis

doi:10.3892/mi.2024.150

May-June 2024 Volume 4 Issue 3

Full Size Image

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

An International Open Access Journal Devoted to General Medicine.

May-June 2024 Volume 4 Issue 3

Full Size Image

Case Report Open Access

Bilateral obstructive uropathy and severe renal dysfunction associated with large prolapsed pedunculated submucosal leiomyoma of the uterus misdiagnosed as an intracervical fibroid: Report of a very rare case and a mini‑review of the literature

Authors:
- Efthymia Thanasa
- Anna Thanasa
- Vasiliki Grapsidi
- Emmanouil Xydias
- Evangelos Kamaretsos
- Apostolos Ziogas
- Ioannis Paraoulakis
- Evagelia Simopoulou
- Maria Mousia
- Ioannis Thanasas
View Affiliations / Copyright

Affiliations: Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece, Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece, Department of Obstetrics and Gynaecology, EmbryoClinic IVF, 55133 Thessaloniki, Greece, Department of Medicine, University of Thessaly, School of Health Sciences, 41334 Larissa, Greece, Department of Pathology, General Hospital of Trikala, 42100 Trikala, Greece

Copyright: © Thanasa et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
Article Number: 26
|
Published online on: March 27, 2024

https://doi.org/10.3892/mi.2024.150
Expand metrics +

Abstract

Pedunculated submucosal leiomyomas of the uterus that prolapse into the vagina are common. In extremely rare cases, large pedunculated submucosal leiomyomas may lead to bilateral obstructive uropathy, causing severe renal dysfunction and potentially being misdiagnosed as intracervical leiomyoma. The present study describes the surgical treatment of a patient with a large prolapsed pedunculated submucosal uterine leiomyoma, which was misdiagnosed as an intracervical fibroid. The patient, of menopausal age, presented with uterine bleeding, anemia and severe renal dysfunction. Upon a physical examination, suspicion arose for a cervical leiomyoma, prompting the decision for imaging. Both transvaginal ultrasound and computed tomography, as well as magnetic resonance imaging confirmed the diagnosis of intracervical leiomyoma, accompanied by bilateral obstructive uropathy due to ureteral compression. The surgical management of the patient with laparotomy was decided. Intraoperatively, a large pedunculated submucosal uterine leiomyoma prolapsing into the vagina was identified. Total hysterectomy and bilateral salpingectomy‑oophorectomy were performed. The immediate post‑operative course was uneventful. At 6 months following surgery, the complete recovery of renal morphology and function was observed. The patient continues to undergo regular follow‑up assessment to date. In the present study, a brief literature review is also provided, emphasizing the significant diagnostic and surgical challenges that may arise in the management of patients with large pedunculated submucosal uterine leiomyomas prolapsing into the vagina.

View Figures

View References

1	Lazaridis A, Hirsch M, Pistofidis G and Odejinmi F: Surgical management of uterine fibroids. Curr Opin Obstet Gynecol. 35:440–445. 2023.PubMed/NCBI View Article : Google Scholar
2	Cook H, Ezzati M, Segars JH and McCarthy K: The impact of uterine leiomyomas on reproductive outcomes. Minerva Ginecol. 62:225–236. 2010.PubMed/NCBI
3	Klatsky PC, Tran ND, Caughey AB and Fujimoto VY: Fibroids and reproductive outcomes: A systematic literature review from conception to delivery. Am J Obstet Gynecol. 198:357–366. 2008.PubMed/NCBI View Article : Google Scholar
4	Giuliani E, As-Sanie S and Marsh EE: Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 149:3–9. 2020.PubMed/NCBI View Article : Google Scholar
5	Stewart EA, Cookson CL, Gandolfo RA and Schulze-Rath R: Epidemiology of uterine fibroids: A systematic review. BJOG. 124:1501–1512. 2017.PubMed/NCBI View Article : Google Scholar
6	Buttram VC Jr and Reiter RC: Uterine leiomyomata: Etiology, symptomatology, and management. Fertil Steril. 36:433–445. 1981.PubMed/NCBI View Article : Google Scholar
7	Turhan N, Simavli S, Kaygusuz I and Kasap B: Totally inverted cervix due to a huge prolapsed cervical myoma simulating chronic non-puerperal uterine inversion. Int J Surg Case Rep. 5:513–515. 2014.PubMed/NCBI View Article : Google Scholar
8	Ben-Baruch G, Schiff E, Menashe Y and Menczer J: Immediate and late outcome of vaginal myomectomy for prolapsed pedunculated submucous myoma. Obstet Gynecol. 72:858–861. 1988.PubMed/NCBI View Article : Google Scholar
9	Al-Shukri M, Al-Ghafri W, Al-Dhuhli H and Gowri V: Vaginal myomectomy for prolapsed submucous fibroid: It is not only about size. Oman Med J. 34:556–559. 2019.PubMed/NCBI View Article : Google Scholar
10	Corte LD, Giampaolino P, Fabozzi A, Sardo AD and Bifulco G: An exceptional uterine inversion in a virgo patient affected by submucosal leiomyoma: Case report and review of the literature. J Obstet Gynaecol Res. 45:466–472. 2019.PubMed/NCBI View Article : Google Scholar
11	Zacharakis D, Athanasiou S, Kathopoulis N, Michala L, Pontikaki A, Angelou K and Grigoriadis T: Large pedunculated submucosal leiomyoma mimicking uterine prolapse. Clin Case Rep. 9(e04319)2021.PubMed/NCBI View Article : Google Scholar
12	Thanasa E, Thanasa A, Kamaretsos E, Paraoulakis I, Ziogas A, Kontogeorgis G, Grapsidi V, Gerokostas EE, Kontochristos V and Thanasas I: Large cervical leiomyoma of the uterus: A rare cause of chronic pelvic pain associated with obstructive uropathy and renal dysfunction: A case report. Cureus. 15(e33387)2023.PubMed/NCBI View Article : Google Scholar
13	Wang J, Li Z and Sun Y: Prolapsed submucosal pyomyoma postpartum, a rare complication of fibroids. BMC Pregnancy Childbirth. 21(132)2021.PubMed/NCBI View Article : Google Scholar
14	Torrance SM, Muhn N, Ellis S, Rebello R and Ramanna R: Role of dynamic MRI in surgical decision-making for a postpartum woman with a prolapsed degenerating uterine leiomyoma. J Obstet Gynaecol Can. 31:446–451. 2009.PubMed/NCBI View Article : Google Scholar
15	Li L, Shen J, Gao Z, Wang X, Tian D, Yang X, Zhou H, Li B, Tang D and Zhang Q: Transvaginal prolapsed submucosal leiomyoma after cesarean section misdiagnosed as bladder prolapse: A case report with literature review. Front Surg. 10(1071247)2023.PubMed/NCBI View Article : Google Scholar
16	Aydın S, Çelik HG, Maraşlı M and Bakar RZ: Clinical predictors of successful vaginal myomectomy for prolapsed pedunculated uterine leiomyoma. J Turk Ger Gynecol Assoc. 19:146–150. 2018.PubMed/NCBI View Article : Google Scholar
17	da Silva BB, da Silva-Sampaio JP and Lopes-Costa PV: Huge prolapsed pedunculated necrotizing submucosal leiomyoma. J Minim Invasive Gynecol. 25:1128–1129. 2018.PubMed/NCBI View Article : Google Scholar
18	Golan A, Zachalka N, Lurie S, Sagiv R and Glezerman M: Vaginal removal of prolapsed pedunculated submucous myoma: A short, simple, and definitive procedure with minimal morbidity. Arch Gynecol Obstet. 271:11–13. 2005.PubMed/NCBI View Article : Google Scholar
19	Sleiman Z, Ayed A, Christoforou C, Noventa M, Vitagliano A, Laganà AS and Buzzaccarini G: Hymen conservative techniques for vaginal surgery-a practical approach. Prz Menopauzalny. 21:64–68. 2022.PubMed/NCBI View Article : Google Scholar
20	Mauri F, Emery SL and Dubuisson J: A hybrid technique for the removal of a large prolapsed pedunculated submucous leiomyoma. J Gynecol Obstet Hum Reprod. 51(102365)2022.PubMed/NCBI View Article : Google Scholar

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Bilateral obstructive uropathy and severe renal dysfunction associated with large prolapsed pedunculated submucosal leiomyoma of the uterus misdiagnosed as an intracervical fibroid: Report of a very rare case and a mini‑review of the literature

This article is mentioned in:

Abstract

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Figure 7

Figure 8

Figure 9

Related Articles