Cervical leiomyomas are benign smooth-muscle tumors. Symptoms may include abnormal vaginal bleeding, vaginal discharge, and dyspareunia. Diagnosis is with pelvic examination or sometimes imaging. Treatment is observation or surgical removal.
Cervical leiomyomas are uncommon. Uterine leiomyomas (fibroids) commonly occur in the uterine corpus and are usually present in patients with cervical fibroids. Large cervical leiomyomas may partially obstruct the urinary tract. Cervical leiomyomas do not prolapse, but some submucosal fibroids prolapse through the cervical canal into the vagina. Prolapsed leiomyomas sometimes ulcerate, become infected, bleed, or a combination.
Symptoms and Signs of Cervical Leiomyomas
Most cervical leiomyomas eventually cause symptoms. The most common symptom is bleeding, which may be irregular or heavy, sometimes causing anemia. Dyspareunia may occur. Infection may cause pain, bleeding, or discharge.
Urinary outflow obstruction causes hesitancy, dribbling, or urinary retention; urinary tract infections may develop.
Diagnosis of Cervical Leiomyomas
Pelvic examination
Sometimes imaging
Diagnosis of cervical leiomyomas is by physical examination. Some are palpable during bimanual examination. Ultrasonography or MRI can help with the diagnosis.
On speculum examination, sometimes a prolapsed submucosal leiomyoma is visible at or beyond the external cervical os. Typically, these are pedunculated and mobile, which differentiates them from cervical leiomyomas, which are usually sessile. A prolapsed submucosal leiomyoma may be friable and ulcerated.
Transvaginal ultrasonography or MRI is done only for the following reasons:
To confirm an uncertain diagnosis
To exclude urinary outflow obstruction
To identify additional leiomyomas
To distinguish between a prolapsed submucosal leiomyoma and a true cervical leiomyoma
Hemoglobin or hematocrit is measured to exclude anemia.
A biopsy is done if needed to rule out other types of cervical masses.
Treatment of Cervical Leiomyomas
Removal of symptomatic leiomyomas
Treatment of cervical leiomyomas is similar to treatment of fibroids. Small, asymptomatic leiomyomas are not treated. Most symptomatic cervical leiomyomas are removed by myomectomy (particularly if childbearing capacity is important) or, if myomectomy is technically difficult, by hysterectomy.
Prolapsed leiomyomas should be removed transvaginally if possible.
Key Points
Cervical leiomyomas are benign.
Most cervical leiomyomas eventually cause symptoms, mainly bleeding; large leiomyomas may partially block the urinary tract.
Diagnose cervical leiomyomas by pelvic examination and sometimes transvaginal ultrasonography or MRI.
Surgically remove symptomatic cervical leiomyomas, usually by myomectomy but, if myomectomy is not possible, by hysterectomy.
