Pelvic Myxoid Leiomyoma Mass between Vagina and Rectum

Abstract

Leiomyomas are the most common pelvic tumors in women. About 20-30% of women older than 35 are affected. Rare conditions of leiomyomas have extrauterine locations. Myxoid degeneration is a rare type of leiomyoma degeneration. We report a case of solid-cystic myxoid leiomyoma in a 53-year-old woman complained of constipation, urinary hesitation, and malodorous vaginal discharge with palpable 17 × 12 cm mass between vagina and rectum. Regarding the inferior location of the mass, a perineal approach was used to enucleate it. This rare location has not been mentioned before. The woman was finally diagnosed by pathologists which was myxoid leiomyoma.

Figure 1

Contrast enhanced computed tomography (CT). (a) Frontal section showing the extension of the mass (M) from the sacrum to the perineum. (b) Transverse section showing the mass (M) compressing the bladder (U) and vaginal canal anteriorly and the rectum posteriorly.

Figure 2

The enucleation process through the transperineal incision and gross appearance of the mass.

Figure 3

(a) Microscopic aspect (×10) showing the bundles of spindle within edematous myxoid stroma. (b) Microscopic aspect (×40) showing the bundles of spindle cells having elongated bland nuclei. (c) Microscopic aspect (×10) showing the positive nuclear response on estrogen receptor.