Prolapsed uterine leiomyoma (fibroid)
- William H Parker, MD
William H Parker, MD
- Clinical Professor
- Department of Obstetrics and Gynecology
- UCLA School of Medicine, Los Angeles
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Howard T Sharp, MD
Howard T Sharp, MD
- Section Editor — Gynecologic Surgery
- Professor and Vice Chair for Clinical Activities
- Department of Obstetrics and Gynecology
- University of Utah Health Sciences Center
Uterine leiomyomas (fibroids) are common benign smooth muscle tumors [1,2]. Fibroids may develop anywhere within the muscular wall of the uterus, including submucosal, intramural, or subserosal positions (figure 1). For women with a pedunculated submucosal fibroid that is contained within the uterine cavity, removal is typically performed using hysteroscopy. Infrequently, uterine contractions will push a pedunculated submucosal fibroid through the cervical canal and it may prolapse into the vagina . Pedunculated fibroids that dilate the cervix or prolapse through the cervix into the vagina can usually be removed via the vagina.
Removal of subserosal or intramural fibroids through a vaginal colpotomy incision is an uncommonly performed procedure that has also been referred to as vaginal myomectomy . This approach has been associated with an increased risk of infection compared with other surgical approaches to myomectomy. This procedure is not discussed here.
Vaginal myomectomy for a prolapsed submucosal uterine fibroid is reviewed here. Hysteroscopic, abdominal, and laparoscopic approaches to myomectomy are discussed separately. (See "Hysteroscopic myomectomy" and "Abdominal myomectomy" and "Laparoscopic myomectomy and other laparoscopic treatments for uterine leiomyomas (fibroids)".)
INCIDENCE AND RISK FACTORS
There are no data regarding the incidence or risk factors of prolapsed uterine leiomyomas in particular. In general, uterine leiomyomas are the most common type of pelvic tumor in women, with a prevalence of up to 80 percent. Submucosal fibroids account for approximately 15 to 20 percent of these and an unknown proportion of submucosal leiomyomas prolapse through the cervix. In our experience, this clinical finding is uncommon, but is not exceedingly rare. The epidemiology and risk factors of uterine leiomyomas are discussed separately. (See "Uterine leiomyomas (fibroids): Epidemiology, clinical features, diagnosis, and natural history", section on 'Prevalence' and "Uterine leiomyomas (fibroids): Epidemiology, clinical features, diagnosis, and natural history", section on 'Risk factors'.)
Prolapse of a submucosal leiomyoma through the cervix may present with symptoms of vaginal bleeding, discharge, or pelvic pain. Some women are asymptomatic, and the finding is noted incidentally on pelvic examination.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Baird DD, Dunson DB, Hill MC, et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188:100.
- Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril 2007; 87:725.
- Golan A, Zachalka N, Lurie S, et al. Vaginal removal of prolapsed pedunculated submucous myoma: a short, simple, and definitive procedure with minimal morbidity. Arch Gynecol Obstet 2005; 271:11.
- Faivre E, Surroca MM, Deffieux X, et al. Vaginal myomectomy: literature review. J Minim Invasive Gynecol 2010; 17:154.
- Dicker D, Feldberg D, Dekel A, et al. The management of prolapsed submucous fibroids. Aust N Z J Obstet Gynaecol 1986; 26:308.
- Parker WH. The utility of MRI for the surgical treatment of women with uterine fibroid tumors. Am J Obstet Gynecol 2012; 206:31.
- Kim JW, Lee CH, Kim KA, Park CM. Spontaneous prolapse of pedunculated uterine submucosal leiomyoma: usefulness of broccoli sign on CT and MR imaging. Clin Imaging 2008; 32:233.
- McCluggage WG, Alderdice JM, Walsh MY. Polypoid uterine lesions mimicking endometrial stromal sarcoma. J Clin Pathol 1999; 52:543.
- Chang A, Natarajan S. Polypoid endometriosis. Arch Pathol Lab Med 2001; 125:1257.
- ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180. Reaffirmed 2016.
- Ben-Baruch G, Schiff E, Menashe Y, Menczer J. Immediate and late outcome of vaginal myomectomy for prolapsed pedunculated submucous myoma. Obstet Gynecol 1988; 72:858.
- MAYES HW. Dührssen's incisions. Am J Surg 1951; 81:303.
- Straub HL, Chohan L, Kilpatrick CC. Cervical and prolapsed submucosal leiomyomas complicating pregnancy. Obstet Gynecol Surv 2010; 65:583.
- INCIDENCE AND RISK FACTORS
- CLINICAL PRESENTATION
- Incidental finding on pelvic examination
- DIAGNOSTIC EVALUATION
- Pelvic examination
- Imaging studies
- Pathology evaluation of mass
- DIFFERENTIAL DIAGNOSIS
- VAGINAL MYOMECTOMY
- Surgical planning
- - Informed consent
- - Operative setting
- - Anesthesia
- - Antibiotic prophylaxis
- - Thromboprophylaxis
- PREGNANT WOMEN
- REFERRAL TO A SPECIALIST
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS