VP63.21: Cervical myomas diagnosed on ultrasound: a case series

Leiomyomas are the most common benign neoplasms of the uterus. Although leiomyomas arise throughout the body in any structure containing smooth muscle, in the pelvis the majority are found in the corpus of the uterus. Leiomyomas of the uterine cervix are an unusual variation in terms of location for a uterine leiomyoma. They are rare and account for ∼5% of uterine leiomyomas. Clinical symptoms of cervical leiomyomas including abnormal uterine bleeding, dysmenorrhea or abdominal distention can be identical to those of uterine leiomyomas. In ultrasonoraphy, they are usually seen as a smoothly rounded mass centreed on the uterine cervix. Echogenicity and signal characteristics are usually similar to leiomyomas of the uterine body. This is a case series of three multiparous women, all in their forties (mean age: 43), completed family size, diagnosed with cervical myoma on ultrasound with varying presentations: profuse vaginal bleeding; hypogastric pain with intermittent vaginal spotting; and hypogastric pain with profuse vaginal bleeding and urinary symptoms. The first case underwent total abdominal hysterectomy, the second case had preoperative ureteral stenting followed by total abdominal hysterectomy with bilateral salpingo-oophorectomy and the third case underwent total abdominal hysterectomy with bilateral salpingectomy after blood transfusion. Postoperative courses of the patients were unremarkable. Intraoperative assessment and histopathologic findings confirmed the initial ultrasound diagnosis of the three cases as cervical leiomyomas. This highlights that ultrasonography remains the first line and a valuable imaging modality for the evaluation of the uterine and cervical anatomy in correlation with the patient's history and clinical scenario. Correct diagnosis can aid in advance planning for the intended surgical procedure and increases the probability of a successful outcome.