Clinical considerations and sonographic findings of a large nonpedunculated primary cervical leiomyoma complicated by heavy vaginal haemorrhage: a case report and review of the literature.

Leiomyomas of the uterine cervix are uncommon. Cervical leiomyomas in non-pregnant women rarely are of clinical significance and their complications include pressure effects on the bladder or urethra, degenerative phenomema and menorrhagia. We present a case of 46-year-old female, gravida 2, para 1 who was presented in the gynaecological emergency room with the chief complaint of profound vaginal bleeding over the previous three weeks with recent passage of clots. Pregnancy test was negative. She suffered from profound orthostatic hypotension and tachycardia. On examination, her abdomen was soft, non-tender, and without rebound, guarding or palpable masses. Bimanual examination was notable for the presence of a large firm mass fixed to the uterine cervix. The cervix was 8 cm dilated and the body of the uterus was felt separate from the mass. The sonographic findings were consistent with a large cervical leiomyoma. Subtotal hysterectomy with salpingo-oophorectomy was performed and the patient's postoperative course was uneventful. In conclusion, in the present case the cause of the heavy vaginal bleeding was a primary cervical fibroid as the uterus attempted to abort it.