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.

双侧梗阻性尿路病变和严重肾功能障碍与子宫的大型脱垂有蒂粘膜下平滑肌瘤相关误诊为宫颈内肌瘤 ： 一例非常罕见的病例报告和文献综述.

• 发表时间: 2024 May-Jun
• 来源期刊: Med Int (Lond)
• DOI: 10.3892/mi.2024.150
• PMID: 38628382
• 文章类型: Case Reports
• 作者列表: Thanasa E,Thanasa A,Grapsidi V,Xydias E,Kamaretsos E,Ziogas A,Paraoulakis I,Simopoulou E,Mousia M,Thanasas I

关键词: computed tomography; intracervical leiomyoma; magnetic resonance imaging; obstructive uropathy; pedunculated submucosal leiomyoma; renal dysfunction; surgical treatment; ultrasound

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.

摘要

脱垂至阴道的子宫粘膜下平滑肌瘤很常见。在极少数情况下，大型带蒂粘膜下平滑肌瘤可能导致双侧梗阻性尿路病变，导致严重的肾功能不全，并可能被误诊为宫颈平滑肌瘤。本研究描述了患有大型脱垂性粘膜下子宫平滑肌瘤的患者的手术治疗。误诊为宫颈肌瘤.病人,更年期年龄，表现为子宫出血，贫血和严重肾功能不全。在体检时，怀疑是宫颈平滑肌瘤,提示成像的决定。经阴道超声和计算机断层扫描，以及磁共振成像证实了宫颈平滑肌瘤的诊断，伴有由于输尿管压迫引起的双侧梗阻性尿路病变。决定了剖腹手术患者的手术治疗。术中,发现一个巨大的带蒂粘膜下子宫平滑肌瘤脱垂到阴道中。进行了全子宫切除术和双侧输卵管切除术。术后立即进行的过程很顺利。手术后6个月,观察到肾脏形态和功能的完全恢复。迄今为止，患者继续接受定期随访评估。在本研究中,还提供了简短的文献综述，强调在处理大型带蒂粘膜下子宫平滑肌瘤脱垂进入阴道的患者中可能出现的重大诊断和手术挑战。