Cervical fibroid: A diagnostic dilemma and operative challenge
Uterine fibroids are the most common benign smooth muscle tumour in women of the reproductive age group. Despite having a fairly high frequency of 70%, uterine fibroid only impacts 20–40% of females symptomatically. Ninety-five percent of leiomyomas are found in the uterine corpus; just one to two percent are seen in the cervical region. These tumours are estrogen-dependent. The cervical fibroid can arise either from the supravaginal or infravaginal portion of the cervix. It may originate from the anterior, posterior, central, or lateral regions. Cervical fibroid is classified as type 8 in the FIGO classification of uterine fibroid. Cervical fibroid may be present with varied symptoms like irregular vaginal bleeding, heavy menstrual bleeding, dysmenorrhea, chronic pelvic pain, and pressure effects caused disturbance in bladder and bowel habits.
Cervical leiomyoma can change the shape of the cervix and cause its lengthening and effacement. It can also cause the uterus to push upwards or the bladder to be drawn up when its size increases, which causes urinary tract infections. Cervical fibroid may have an impact on a woman’s obstetric outcomes because it can result in abortion, infertility, early discomfort, more surgical intervention, and a protracted postpartum recovery. Sometimes it is difficult to reach the diagnosis of cervical fibroid as it mimics various other gynaecological conditions or because of some atypical presentation like polypoidal vaginal mass, incarcerated procidentia, chronic uterine inversion, uterocervical descent, ovarian mass, acute urinary retention, or cervical carcinoma.
A two-year retrospective analysis of women diagnosed with cervical leiomyoma was conducted at Obstetrics and Gynaecology department, PGIMS Rohtak (a tertiary care institute in Northern India). A total of 24 cases diagnosed with cervical fibroid (CF) were studied.
This study aimed to find out how common cervical fibroids are among different ages, where they start, the most common symptom that led women to the hospital, as well as any site-specific symptoms; also to find out if there is a link between size and symptoms, surgical problems, and the development of cancer.
75% of the females had vaginal bleeding, 44.6% had heavy menstrual bleeding, 33.3% had irregular bleeding, and one had postmenopausal bleeding. 41.6% had urinary symptoms; 1.5% complained of vaginal discharge; difficulty in stools (16.6%); and leiomyosarcoma (8.3%). Authors could not find a clear demarcation of presenting symptoms between anterior and posterior fibroid. It was discovered that the development of malignancy and bladder and intestinal problems was linked to an increase in CF mass, while severe anaemia and vaginal bleeding were not.
Cervical fibroid is mostly benign, can be present at extremes of age, and its atypical presenting symptoms pose difficulty in diagnosis. Vaginal bleeding and retention of urine are the most common symptoms. Central and supravaginal fibroids are difficult to operate. Preoperative clinical evaluation, radiological imaging, and proper intraoperative delineation of pelvic anatomy can help in their successful management and anticipating intraoperative complications. Intracapsular enucleation is the best approach to preventing ureteric injury. Its management is still a challenge for gynaecologists, as they are difficult to operate due to their proximity to the pelvic structure. In large cervical firoids, always suspect malignancy before moving to surgery, and hidden cervical malignancy can coexist.
Source: Dahiya et al. / Indian Journal of Obstetrics and Gynecology Research 2024;11(3):409–414
