Laparoscopic management of a pelvic retroperitoneal leiomyoma-case report

Leiomyomas are benign tumors frequently found in the fourth and fifth decades of life. Although the uterus is the most common site of origin of leiomyomas, they can develop at any site where there is smooth muscle cell. Extrauterine leiomyomas are not common and usually their diagnostic are more challenging. In this paper, we report one case of pelvic retroperitoneal leiomyoma associated to vulvar/perineal leiomyomas. A 47-year-old female patient presented with a 6-month history of deep dyspareunia, abdominal pain, dysuria, and pain during defecation. She had a previous history of two open myomectomies, a supracervical hysterectomy associated to the exeresis of a vulvar leiomyoma, and a left salpingo-oophorectomy. On vaginal examination, there was a tender and firm mass at the vaginal vault and along the posterior vaginal wall. There was another tumor at the left vulvar/perineal region measuring around 6 cm. Magnetic resonance imaging demonstrated the presence of a mass at the Douglas pouch measuring 14x10x10 cm suggestive of uterine leiomyomatosis. She underwent a successful laparoscopic resection of the pelvic tumor with an operative time of 210 min. The vulvar/perineal lesions were resected by vaginal approach. She presented an uneventful postoperative course and was discharged home 3 days after surgery. Histopathology confirmed the diagnosis of leiomyomas. Laparoscopic approach for pelvic retroperitoneal leiomyoma is feasible. It is important to keep in mind the possibility of this entity as a differential diagnosis of retroperitoneal masses in women.