An Unusual Presentation of a Large Cervical Fibroid—Case Report

Leiomyoma is the most common of all uterine and pelvic tumors. The incidence of leiomyoma is 20% in the reproductive age group, but only 1-2% are found in the cervix. Cervical fibroid develops usually in the supravaginal part of cervix. The symptoms most commonly presented are retention of urine, menstrual abnormalities, constipation, and sometimes can present only as an abdominal mass. Large cervical fibroids are rare and can present with surgical difficulties at the time of either myomectomy or hysterectomy, and have an increased risk of urinary tract injuries and intra operative bleeding. We hereby present four such cases of large cervical fibroid, in women of varying parity from 0 – 3 who underwent a hysterectomy successfully. Dissecting and enucleating a large fibroid (whether cervical or uterine) by limiting the dissection to within the capsule of the fibroid is a key surgical technique to prevent ureteric injury in addition to careful dissection of ureters and bladder and clamping any pedicle with keeping ureters under direct vision. We thereby conclude with the note, that large cervical fibroids are a very rare scenario and require an expert hand to operate them to avoid blood loss, prevent inadvertent injury to ureters or the bladder.

Journal of Mid-life Health, 2016

Uterine fibroids are the most common uterine neoplasm of uterus and the female pelvis and the most common indication for hysterectomy worldwide. When the fibroid is large and fills the whole pelvis or is pedunculated, it becomes difficult to differentiate from ovarian mass clinically. Cervical fibroids pose enormous surgical difficulty by virtue of their relative inaccessibility and proximity to the anterior bladder, posterior rectum, and distorting the normal anatomical relationship of pelvic structures. A cervical fibroid especially with degenerative changes mimics an ovarian tumor and poses a clinical dilemma. This case is also exemplified for its rarity and diagnostic difficulty.

International Journal of Clinical Obstetrics and Gynaecology, 2021

Cervical fibroids are rare pelvic tumours with varying clinical presentations. Clinical and radiological evaluation of these fibroids help in deciding the treatment approach. There will be surgical difficulties due to their close proximity to pelvic organs like bladder, ureters and rectum. Hence proper intraoperative delineation is important. We present a series of four cases of cervical fibroid with different presentations and management. All these cases were evaluated and surgically managed without complications. The first and third case presented with huge mass per abdomen and pressure symptoms. Both underwent exploratory laparotomy where fibroid was enucleated followed by hysterectomy. The second and fourth case mimicked like a large polyp. In both the cases, cervical fibroid was excised vaginally and was followed by hysterectomy. Histopathological examination was suggestive of cervical leiomyoma. Therefore, cervical fibroid as a differential diagnosis should always be considered while evaluating any pelvic masses.

Cervical fibroids are a rarity as compared to fibroids arising from other parts of the uterus. These rare fibroids account for 1-2% of all fibroids. They arise from supravaginal or vaginal portion of cervix. They can be either anterior, posterior, central or lateral. Our case is unique in many ways, firstly the huge size of the tumor, its rapid growth and its management laparoscopically. We report a case of 47-year-old female who presented with complain of pain abdomen and menorrhagia since last 10 years. Abdominal examination revealed a huge firm mass corresponding to 34 weeks size gravid uterus with well defined margins. The lower pole of the mass could not be reached and mobility was not there due to its size. MRI revealed a large fibroid arising from the posterior wall of the cervix displacing the uterus to the left and anteriorly. After necessary investigations, arranging adequate blood and written informed consents, patient was taken up for laparoscopic hysterectomy. Intraoperative findings were of a large cervical fibroid seen extending from depth of the pelvis uptil four inches below xiphisternum and abutting right lateral wall. Uterus was deviated to the left side by the tumor. Left tube and ovary were normal looking, but right tube was stretched over the tumor along with the ovary. Hysterectomy was done including the separation of the fibroid from all its attachments, but in view of large size of the mass and high suspicion of sarcomatous changes within the tumor, laparotomy was done to deliver out the tumor with uterus and bilateral adnexa. The operative time was around 3 hours and estimated blood loss during the surgery was around 500ml. Patient was given 2 units of PCV and 2 units of FFP's. Her postoperative period was uneventful. Histopathology report was in conformity with that of a cervical fibroid. To conclude, management of such cases laparoscopically helps in decreasing blood loss during surgery to a large extent and helps in decreasing patient morbidity in the hand of experienced endoscopist team.

The European Research Journal

Cervical fibroids are rare neoplasms of uterine origin whose management has not been standardized. Cervical fibroids, which can be challenging in surgical management, can become a difficult problem for the surgeon when neglected or asymptomatic and reach gigantic dimensions. Suspending the aorta abdominalis or arteria illiaca communis with vascular tapes and balloting the uterus with the help of vaginal taping while searching for the correct cleavage may reduce the risk of intraoperative hemorrhage and adjacent organ injury, as well as may be guide for the steps of the operation. Management of neglected giant cervical fibroids may not be suitable for testing alternative treatment methods to surgery used in the treatment of uterine neoplasms. However, surgical management will also be challenging. For this reason, the technique we describe can help the surgeon with clues that should be considered in the surgical management of these patients.

Cervical fibroids are a rarity as compared to fibroids arising from other parts of the uterus. These rare fibroids account for 1-2% of all fibroids. They arise from supravaginal or vaginal portion of cervix. They can be either anterior, posterior, central or lateral. Our case is unique in many ways, firstly the huge size of the tumor, its rapid growth and its management laparoscopically. We report a case of 47-year-old female who presented with complain of pain abdomen and menorrhagia since last 10 years. Abdominal examination revealed a huge firm mass corresponding to 34 weeks size gravid uterus with well defined margins. The lower pole of the mass could not be reached and mobility was not there due to its size. MRI revealed a large fibroid arising from the posterior wall of the cervix displacing the uterus to the left and anteriorly. After necessary investigations, arranging adequate blood and written informed consents, patient was taken up for laparoscopic hysterectomy. Intraoperative findings were of a large cervical fibroid seen extending from depth of the pelvis uptil four inches below xiphisternum and abutting right lateral wall. Uterus was deviated to the left side by the tumor. Left tube and ovary were normal looking, but right tube was stretched over the tumor along with the ovary. Hysterectomy was done including the separation of the fibroid from all its attachments, but in view of large size of the mass and high suspicion of sarcomatous changes within the tumor, laparotomy was done to deliver out the tumor with uterus and bilateral adnexa. The operative time was around 3 hours and estimated blood loss during the surgery was around 500ml. Patient was given 2 units of PCV and 2 units of FFP's. Her postoperative period was uneventful. Histopathology report was in conformity with that of a cervical fibroid. To conclude, management of such cases laparoscopically helps in decreasing blood loss during surgery to a large extent and helps in decreasing patient morbidity in the hand of experienced endoscopist team. Obstet Gynecol Res 2018; 1 (2): 065-071

Journal of SAFOG, 2020

Fibroids are an extremely common benign neoplasm of uterine smooth muscle but fibroids originating in cervix are uncommon (1% of all fibroids). Huge cervical fibroids pose operative challenge in both hysterectomy and myomectomy. We report two cases with a 24-week-sized central cervical fibroid with uterus sitting atop, i.e., lantern on the St. Paul's Cathedral appearance. The younger patient desirous of future childbearing underwent open cervical myomectomy followed by uterine cervix reconstruction and the postmenopausal women underwent hysterectomy.

2017

SAŽETAK Cilj ovog istraživanja je odrediti usvojenost i konceptualno razumijevanje makrokoncepta Razmnožavanje i razvoj organizma među učenicima 7. i 8. razreda osnovnih škola, na temelju učeničkih odgovora na pitanja uz makrokoncept Razmnožavanje i razvoj organizma na Županijskom natjecanju iz biologije 2015. i 2017. godine. Analiza učeničkih odgovora uključivala je specifično kodiranje odgovora i tumačenje biološkog značenja odgovora učenika. Izdvojeni su i objašnjeni problemi koje učenici pokazuju u svojim odgovorima kao i njihove miskoncepcije vezane uz koncept razmnožavanje. Utvrđeno je i opisano postojanje niza problema kod usvojenosti koncepta razmnožavanje te su kao najizraženije uočene miskoncepcije uz ključni koncept životni ciklus stanice i organizma te kod razumijevanja koncepta oplodnje. Utvrđene miskoncepcije ukazuju na nužnu promjenu organizacije nastavnih sadržaja biologije, kao i na potrebu uvođenja novih nastavnih strategija s naglaskom na aktivnost i samostalni ra...

Esta traducción fue hecha sin fines de lucro. Es una traducción de fans para fans. Si el libro llega a tu país, apoya al escritor comprándolo. También puedes apoyar al autor con una reseña, siguiéndolo en las redes sociales y ayudándolo a promocionar su libro.

Paranoá, 2022

restoration defending the idea that Cesare Brandi´s “Teoria del restauro” has become antiquated and is even impossible to comprehend, due to the identification of inherent contradictions and the difficult reading of its complex form of Italian language. This article aims to discuss some of the points presented by the Spanish author Salvador Muñoz Viñas as contradictions found in Brandi´s theory. Are they really contradictions? Reductionist interpretations end up leading to an polarized debate, that tends to fall into criticism for the sake of criticism. Here we would like to emphasize the need to get over this unproductive dichotomy between “brandians par excellence” and “postmodernists” of conservation. To the development of our argument, we will discuss the concept of restoration, the themes of integrity,authenticity and the brandian concept of potential unity. Key-Words: restoration; Cesare Brandi; Muñoz Viñas; potential unit; integrity; authenticity.