IMAGE INTEREST

Brunei Darussalam International Journal

1
Cipta Pramana, 2Elsa NauraKhansa, 3Tassya Annisa
1
Department of Obstetrics and Gynecology K.R.M.T. Wongsonegoro General Hospital
Semarang, Indonesia / Medicine Faculty of Tarumanagara University Jakarta,Indonesia
2,3
Medicine Faculty of Trisakti University Jakarta,Indonesia

Corresponding Author:Cipta Pramana, K.R.M.T. WongsonegoroGeneral Hospital, Fatmawati St. No 1

Semarang, Central Java, Indonesia50272. Call: +62813-2611-8651 Email :pramanacipta@yahoo.com

A 40-year-old woman from Indonesia presented history of heavy menstrual bleeding

sometimes with clots and irregular per vagina bleeding since 1 month ago. She reportedlow

abdominal pain, abdominal dilated and pelvic pain. She had symptom of anaemia like

lethargy.General examination showed her blood pressure was 150/100mmHg. Speculum

examination showed a round-shaped mass amount duck’s egg out of external uterine ostium like

had pedunculated from uterine cavity and showed blood on canaliscervicalis. On vaginal toucher

examination showed fluxus, a round-shaped mass amount duck’s egg was palpable, slippery

surface, smooth, not weak, not slinger pain. The size of corpus uterine as big as a fist.
What is the diagnosis?

Answer: Submucous Pedunculated Uterine Leiomyoma

Submucous uterine leiomyoma are common benign tumors in the wall uterus, which are

present in approximately 15 - 20% cases and it rarely prolapse into the vagina through the

cervical canal, especially when it had pedunculated.1

Patient with uterine leiomyoma, generally present with symptoms irregular and heavy

menstrual bleeding, pelvic pain, pressure effects, and anaemia. 1,2 In this case, patient presented

history of irregular and heavy menstrual bleeding since 1 month ago, lethargy, low abdominal

pain, abdominal dilated and pelvic pain. On hematological examination were abnormal,

hemoglobin decreased (Hb: 9.2 g/dL).

In doubtful case, imaging modalities such as Ultrasound or Magnetic Resonance pelvic

can required to support the diagnose.1 In our case, we diagnosed the patient with anamnesis,

physical examination, speculum examination, vaginal toucher and hematological examination.

We did not require imaging for this case, because the result from speculum examination and

vaginal toucher can diagnosed patient with submucous pedunculated uterine leiomyoma.

Hysterectomy is the most frequent treatment for uterine leiomyoma and this procedure is

safe for prolapsed pedunculated uterine leiomyoma.The advantage of hysterectomy is

elimination of symptoms without risk of recurrence.Hysterectomy was required in woman with

multiple uterine leiomyomas.3 In this case, the uterus had 2 uterine leiomyomas which are

submucous pedunculated uterine leiomyoma and intramural leiomyoma. So, that is the reason

why we did total abdominal hysterectomy for patient..

 The conclusion is although the incidence rate of submucous uterine leiomyoma is low but

it can cause more serious clinical symptoms i.e severe anaemia caused prolonged and excessive

menstrual bleeding.

References

1. BAŞER E, ERKILINÇ S, Emre ÖZ, GÜNGÖR T. HAYATI TEHDİT EDEN VAJİNAL

KANAMA İLE PREZENTE OLAN VAJENE DOĞMUŞ SUBMÜKÖZ MYOMUN ACİL

CERRAHİ TEDAVİSİ: OLGU SUNUMU. Jinekoloji-ObstetrikveNeonatoloji Tıp Dergisi. 2013

Dec 1;10(40).

2. Matytsina-Quinlan, L., &Matytsina, L. (2014). Submucosal uterine fibroid prolapsed into

vagina in a symptomatic patient with IUS. Case Reports, 2014(apr16 1), bcr2014203877–

bcr2014203877. doi:10.1136/bcr-2014-203877.

3. Aydın S, GökseverÇelik H, Maraşlı M, Bakar RZ. Clinical predictors of successful vaginal

myomectomy for prolapsed pedunculated uterine leiomyoma. J Turk GerGynecol Assoc.

2018;19(3):146–150. doi:10.4274/jtgga.2017.0135.