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      Urethral leiomyoma: A rare neoplasm

      case-report

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          Abstract

          Extrauterine leiomyoma is a rare benign tumor, originating from smooth muscle cells, most often localized in the uterus. Extrauterine localization of leiomyoma is extremely rare. The presence of a neoplasm near the urethra always poses a challenge for differential diagnosis. Variety of pathologies sharing similar clinical findings requires further diagnostic testing and doctor alertness. We present the clinical case of urethral leiomyoma in a female patient aged 42 years complaining of frequent urination and vulval mass. The patient underwent neoplasm removal with further histologic examination revealing urethral leiomyoma. The article features the diagnosis and treatment of this rare pathology.

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          Periurethral masses: etiology and diagnosis in a large series of women.

          A Flisser, Georgia Panagopoulos, Jerry Blaivas … (2004)
          To describe the differential diagnosis of periurethral masses in a consecutive series extracted from a single tertiary urogynecologic practice database. A patient database of a private urology and urogynecology practice with 1,950 women was searched for patients who were found to have a periurethral mass during the accrual dates of 1994 to 2002, and these records were reviewed for diagnostic testing and results. All women provided a history, completed a questionnaire, and underwent physical examination, voiding diary, cystoscopy, and videourodynamic testing; selected patients then underwent additional imaging. Seventy-nine (4%) patients aged 41.2 +/- 14 years were identified. Of these, 72 (91%) had been referred for evaluation of persistent irritative lower urinary tract symptoms or incontinence. Seven patients (9%) had been referred specifically because of a periurethral mass. Sixty-six patients (84%; 95% confidence interval [CI] 73%, 91%) had urethral diverticula, of which 4 (6%; 95% CI 2%, 14.8%) contained malignancies. Six patients (7%; 95% CI 3%, 15%) had vaginal cysts histologically identified as fibromuscular tissue, 4 (5%; 95% CI 1%, 12%) had leiomyomata, and 2 (2.5%; 95% CI 0.03%, 8.8%) had ectopic ureteroceles. Two patients had vaginal squamous cell carcinomas (2.5%; 95% CI 0.03%, 8.8%), and 1 had an infected granuloma. Masses were palpable in 42 patients (53.8%; 95% CI 42%, 64%) and in 37 patients either were encountered at surgery (n = 5) or were urethral diverticula diagnosed by voiding cystourethrogram (n = 32). Periurethral masses were encountered in less than 4% of our patient sample. Most masses were urethral diverticula; however, the differential diagnosis included leiomyoma, vaginal cysts, and malignancy. Masses were generally either palpable or seen at imaging studies performed during evaluation of lower urinary tract symptoms.
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            Leiomyomas of the female urethra and bladder: a report of five cases and review of the literature.

            D Jung, Sang Bai, S. H. Kim … (2007)
            Through the experience of five cases of leiomyoma developed in the female bladder and urethra with a review of the literature, we have made an effort to characterize the association of symptom with the size and location of the tumor and demonstrate an appropriate treatment. The study population was composed of patients who underwent surgery for bladder or urethral leiomyoma in our hospital from March 1990 to April 2005. Their medical records were reviewed retrospectively concerning the symptom, size and location of leiomyoma, the result of cystoscope and radiological examination, surgical method, pathologic report, complications, and recurrence. Four cases were diagnosed as urethral leiomyoma and one case as bladder leiomyoma. All patients with urethral leiomyoma were admitted for the chief complaint of a palpable tumor. When the tumor size was small, if it was located on the lateral side of the urethra, it was asymptomatic, but if located in the midline, it presented irritative or obstructive symptom. When it was big, if located on the lateral side, it presented irritative rather than obstructive symptom, and if located in the midline, it presented obstructive symptom. One case of bladder leiomyoma was discovered incidentally during ultrasonic exam. In all five cases, surgical removal was performed and complications or recurrence were not detected afterwards. Bladder and urethral leiomyomas are very rare and cause diverse manifestations from asymptomatic to irritative or obstructive symptom. It is presumed that the location and size of the tumor are associated with symptom. Unless it is the case with severe hemorrhage or obstructive acute renal failure, immediate surgery is not required. However, it is desirable to distinguish leiomyoma from malignant or other benign tumors by surgical biopsy or removal.
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              Ureteral endometriosis and coexistent urethral leiomyoma in a postmenopausal woman.

              Andrew Strang, Scott W Lisson, Steven Petrou (2016)
              We report the case of a postmenopausal woman with a synchronous obstructing intrinsic endometrioma of the left ureter and a coexistent periurethral leiomyoma. Endometriosis in postmenopausal women is a rare clinical entity usually associated with exogenous estrogen use. Urethral leiomyomas are also rare, with only 40 cases reported in the literature. Ovarian hormones are believed to influence the growth of leiomyomas. We report the genitourinary presentation of 2 separate disease entities with known hormonal influence in a postmenopausal woman receiving estrogen replacement therapy. We believe the patient's hormonal milieu affected the development of her concurrent pathology.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Urol Ann
                Journal ID (iso-abbrev): Urol Ann
                Journal ID (publisher-id): UA
                Title: Urology Annals
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0974-7796
                ISSN (Electronic): 0974-7834
                Publication date (Print): Apr-Jun 2021
                Publication date (Electronic): 04 March 2021
                Volume: 13
                Issue: 2
                Pages: 194-197
                Affiliations
                [1 ]Department of Urology, St. Luke's Clinical Hospital, Saint-Petersburg, Russia
                [2 ]Department of Urology, Military Medical Academy Named After S.M. Kirova, Saint-Petersburg, Russia
                [3 ]Department of Hospital Surgery, Saint-Petersburg State University, Medical Faculty, Saint-Petersburg, Russia
                [4 ]Department of Urology, North-Western State Medical University Named After I.I. Mechnikov, Saint-Petersburg, Russia
                Author notes
                Address for correspondence: Dr. Daria Yu Chernysheva, St Luke's Clinical Hospital, Saint-Petersburg 194044 Russian. E-mail: daria.chern@ 123456gmail.com
                Article
                Publisher ID: UA-13-194
                DOI: 10.4103/UA.UA_90_20
                PMC ID: 8210724
                PubMed ID: 34194152
                SO-VID: 05f24be7-9f46-4a20-b851-97a35b09f20c
                Copyright © Copyright: © 2021 Urology Annals
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 09 June 2020
                Date accepted : 05 January 2021
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Urology
                Keywords: female urethra,neoplasm,urethral leiomyoma
                Data availability:
                ScienceOpen disciplines: Urology
                Keywords: female urethra, neoplasm, urethral leiomyoma

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