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Year : 2000  |  Volume : 10  |  Issue : 3  |  Page : 159-160
Leiomyoma of the female urethra


1 Dept of Radiodiagnosis, AIIMS, New Delhi, India
2 Dept of Urology, AIIMS, New Delhi, India

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Keywords: urethra, vagina, leiomyoma, MRI, ultrasound

How to cite this article:
Jain R, Sawhney S, Bandhu S, Seth A. Leiomyoma of the female urethra. Indian J Radiol Imaging 2000;10:159-60

How to cite this URL:
Jain R, Sawhney S, Bandhu S, Seth A. Leiomyoma of the female urethra. Indian J Radiol Imaging [serial online] 2000 [cited 2019 Sep 20];10:159-60. Available from: http://www.ijri.org/text.asp?2000/10/3/159/30587
Leiomyoma of the female urethra is an unusual entity. To date 35 reports exist in literature [1]. We report an additional case, highlighting for the first time, the imaging features of this rare lesion on MRI and transvaginal ultrasonography (TVUS).


   Case Report Top


A thirty-eight-years old woman presented with history of dysuria of six months duration. At per vaginal examination, a smooth mass was felt through the anterior vaginal wall. Cystoscopy showed a submucosal mass projecting into the bladder base. The urethral and bladder mucosa were normal.

A contrast cystogram showed an extrinsic lobulated mass elevating the bladder base and projecting into the bladder lumen [Figure - 1]. A transabdominal ultrasonography showed a smooth lobulated heterogeneous iso-to hypo-echoic solid mass with a whorled appearance projecting into the bladder base [Figure - 2].

The patient was examined by transvaginal ultrasonography (TVUS) with a catheter placed within the urethra. The study revealed a smooth, solid, slightly heterogeneous mass based on the urethra (identified by the catheter) and projecting into the bladder base. [Figure - 3].

Axial MRI revealed a lobulated, smoothly marginated mass seen to arise from the right antero-lateral aspect of the urethra [Figure - 4]. The urethra was seen to be displaced to the left and the vagina was seen separate from the mass. Coronal scans showed the mass projecting superiorly into the bladder base [Figure - 5]. The mass showed homogeneous medium signal intensity on T1W images. On T2W images, the mass was of medium signal intensity with slight heterogeneity due to a few ill-defined high signal intensity foci. Post-contrast evaluation was not done.

The patient was diagnosed as having a solid benign neoplasm of the urethra projecting into bladder base and lumen, possibly a leiomyoma.


   Discussion Top


Leiomyomas are benign tumors of smooth muscle origin and are rarely found in the urinary tract. They are known to involve in decreasing order of frequency, the kidney, bladder and urethra [2],[3]. Leiomyomas of the female urethra are exceedingly rare. In a review of 394 lesions of the female urethra between 1932 and 1958, no leiomyoma was found [2]. In a review of literature, we were able to find 35 case reports of leiomyoma affecting the female urethra [1].

Urethral leiomyomas are more frequent in women than in men [4]. The mean age of patients at presentation is 34 years; the diameters of the tumors ranged from 1 to 40 cm [1]. The lesions appear to be hormonally sensitive with reports of accelerated growth during pregnancy [3],[5]. Clinical presentations have included periurethral masses, urinary tract infection, hematuria, dyspareunia and obstruction [1],[3],[4],[5]. The differential diagnosis of a clinically apparent urethral / paraurethral mass includes a urethral diverticulum, ureterocele, urethral carcinoma, ectopic ureterocele, Gartner's duct cyst, papilloma, polyp and mesenchymal tumor [1],[3]. Solid benign tumors of the urethra most commonly are papillomas, polyps and least commonly, leiomyomas. Other tumors may be neurofibromas and adenomas [2].

Imaging has not been routinely used for diagnosis in previously reported cases. In only three of the 35 cases reported so far, was sectional imaging used for pre-operative diagnosis. Transabdominal sonography was used in two cases [4],[6] while MRI was used in one [7].

To the best of our knowledge, this is the first time that transvaginal sonography has been used for assessment of this lesion. MRI features of bladder leiomyomas have been described in three reports [8]. Maya et al in 1992 and Tomoe et al in 1991 described bladder leiomyomas as having medium signal intensity on T1W images and homogeneous low signal intensity on T2W images. In our patient, the urethral leiomyoma was seen to have medium signal on both sequences. On TVUS, a homogeneous solid mass was identified, based on the urethra (identified by the in-situ catheter) and projecting into the bladder base on the right side.

Besides the report of an unusual entity, we also described for the first time, MRI and TVUS characteristics of a urethral leiomyoma. We believe that benign lesions of the urethra may be better characterised pre-operatively by MRI, which is especially useful in differentiating entities like leiomyoma, from clinically common entities such as urethral diverticulae or cysts. We found TVUS very helpful in delineating the relationship of the lesion to the urethra and recommend its use in such cases in future.

 
   References Top

1.Leidinger RJ, Das S. Leiomyoma of the female urethra. A report of two cases. J Reprod Med 1995; 40: 229-231.   Back to cited text no. 1    
2.Sheild DE and Weiss RM. Leiomyoma of the female urethra. J Urol 1973; 109: 430-431.   Back to cited text no. 2    
3.Cheng C, Mac Moune Lai F and Chan PSF. Leiomyoma of the female urethra: A case report and review. J Urol 1992; 148: 1526-1527.   Back to cited text no. 3    
4.Lee Ming Chan, Lee Sing-Der, Kuo Huang - Ting et al . Obstructive leiomyoma of the female urethra: report of a case. J Urol 1995; 153: 420-421.   Back to cited text no. 4    
5.Fry M, Wheelar J S, Mata J A et al . Leiomyoma of the female urethra. J Urol 1988; 140: 613-614.   Back to cited text no. 5    
6.Elia G, James W, Ballard CA et al . Diagnostic considerations in co-existing bladder and urethral leiomyomata: a case report. J Reprod Med 1995; 40: 670-672.   Back to cited text no. 6    
7.Cornella JL, Larson TR, Lee RA et al . Leiomyoma of the female urethra and bladder: Report of 23 patients and review of the literature. Am J Obstet Gynecol 1997; 176: 1278-1285.   Back to cited text no. 7    
8.Maya MM, Slywotzky C. Urinary bladder leiomyoma: Magnetic Resonance Imaging findings. Urol Radiol 1992; 14: 197-199.  Back to cited text no. 8  [PUBMED]  

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Correspondence Address:
Rajeev Jain
Dept of Radiodiagnosis, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]



 

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