Rare Case of Vaginal Leiomyoma – A Diagnostic Challenge to Surgeons and Gynecologists

Aim : To present a rare case report of a large vaginal leiomyoma that was resected by combined laparoscopic and perineal approach.

Presentation of Case: A 33 year old lady presented with a perianal swelling. Initial evaluation showed a large mass in rectovaginal space and peri-rectal region on right side. After resection by combined laparoscopic and perineal approach, the final histopathology and immunohistochemistry were suggestive of Vaginal Leiomyoma.

Discussion: Most common extra-uterine sites for leiomyoma are broad ligament, ovarian ligament and round ligament and their incidence is <1%. Vaginal involvement is extremely rare and unusual. Its accurate diagnosis is difficult to establish by preoperative imaging. The final diagnosis can be made only from the histopathology and immunohistochemistry of the resected specimen.

Conclusion: Posterior vaginal leiomyoma is a rare tumor and high index of suspicion is essential to diagnose pre-operatively. Surgical excision remains the mainstay of the treatment.