A Case of a Refractory Bleeding Giant Vaginal Wall Cavernous Hemangioma Successfully Managed with Sclerotherapy

Abstract

BACKGROUND Vaginal wall hemangiomas are extremely rare, benign, vascular tumors of the female genitalia. Most cases occur in childhood, but a few cases can be acquired; however, the mechanism of hemangioma formation remains unknown. Most hemangiomas involving female genital organs are small and asymptomatic. However, huge hemangiomas can cause irregular genital bleeding, infertility, and miscarriage. Surgical excision and embolization are the most common treatment options. We reveal that sclerotherapy achieved good outcomes in a patient with an intractable huge vaginal wall hemangioma. CASE REPORT A 71-year-old woman visited a local doctor with concerns of frequent urination. A ring pessary was inserted after a diagnosis of pelvic organ prolapse. However, symptoms did not improve, and the patient consulted another hospital. The previous physician diagnosed vaginal wall tumors and prolapse and performed a colporrhaphy. However, she was referred to our hospital with heavy intraoperative bleeding. Imaging examination revealed a huge hemangioma on the vaginal wall, which was histologically diagnosed as a cavernous hemangioma. Angiography revealed hemorrhage in the right peripheral vaginal artery. Owing to concerns regarding extensive vaginal wall necrosis caused by arterial embolization, sclerotherapy using monoethanolamine oleate was selected. Hemostasis was achieved 1 month after sclerotherapy, and postoperative imaging showed the lesion had shrunk in size. No recurrence of hemangioma was observed 19 months after surgery. CONCLUSIONS We report a case of a large vaginal wall intractable bleeding hemangioma. Sclerotherapy can be a suitable treatment option for large vaginal hemangiomas that are too extensive to be treated using surgery or arterial embolization.

Figure 1.

(A) Hemangioma protruding from the vagina (white arrowhead); urethral meatus (yellow arrow); labia minora (white arrow). (B) Eruptive massive hemorrhage was noted with puncture of vaginal wall hemangioma (white arrowhead). (C) Hemoglobin (Hb) change during hospitalization and visits to previous physician.

Figure 2.

The right vaginal wall is visible using a vaginal speculum. Bleeding from vaginal wall at 9 o’clock (white arrowhead).

Figure 3.

(A) Dynamic computed tomography scan (axial) of the pelvic region in the arterial layer showing a strong contrast effect in the entire vagina, which is suggestive of abundant blood flow (white arrowheads). Urinary bladder (white arrow), rectum (yellow arrow). (B) Two months after embolization. Vaginal wall hemangioma is obscured (white arrowhead); urinary bladder (white arrow); rectum (yellow arrow). (C) Contrast-enhanced magnetic resonance image (T2, sagittal) of the pelvic region showing the entire vaginal wall seemed to be replaced by a hemangioma with a diameter of 10 cm (white arrowheads); urinary bladder (white arrow); rectum (yellow arrow). (D) Four months after sclerotherapy; vaginal wall hemangioma became obscured; uterus (white arrow); vagina (yellow arrow).

Figure 4.

(A) Early layer of contrast injection to the right vaginal artery angiography. (B) Leakage of contrast medium observed from the peripheral blood vessels (white arrowhead), which was considered to be the cause of the bleeding.

Figure 5.

(A) Transvaginal ultrasound probe with an egg collection needle attached. The egg collection needle protrudes from the tip (white arrowheads). (B) Monoethanolamine oleate is injected and hemangioma is contrasted (white arrowhead).