Uterine leiomyomas are common benign smooth muscle tumors predominantly affecting women of reproductive age. In postmenopausal women, they are rare due to the hypoestrogenic state, which usually leads to fibroid regression. Pedunculated submucosal leiomyomas prolapsing through the cervix into the vagina are rare, especially in postmenopausal women, and may mimic cervical or vaginal masses, posing diagnostic and therapeutic challenges particularly in low-resource settings. Case presentation: Here we present a rare case of a 56-year-old, P4L4, 8 years postmenopausal woman from Northern Tanzania who presented at our facility with a 1-year history of heavy, prolonged vaginal bleeding associated with episodes of non-foul-smelling watery per vaginal discharge, lower abdominal pain, and signs of anemia. An abdominal CT scan with contrast revealed a well circumscribed pedunculated soft tissue dense heterogeneous mass with mild enhancement measuring (10 × 8 × 9 cm) in size arising from the endocervical canal and projecting into the upper vaginal canal. A total vaginal hysterectomy and bilateral salpingo-oophorectomy was performed. Histopathological findings identified the diagnosis of uterine leiomyoma type 0 according to FIGO classification. To date, regular follow-up evaluation has shown no evidence of tumor recurrence. Clinical discussion: The occurrence of giant prolapsed submucosal leiomyomas in postmenopausal women is exceedingly rare due to the natural regression of fibroids after menopause. These masses can mimic malignancy, leading to diagnostic uncertainty. Prompt recognition and surgical management are essential to prevent complications such as hemorrhage, infection, or urinary obstruction. Conclusion: This case highlights a rare presentation of a huge pedunculated submucosal leiomyoma in a postmenopausal woman mimicking a cervical mass. Careful correlation of clinical presentation and imaging findings can aid preoperative assessment; however, definitive diagnosis relies on histopathological examination. Awareness of this unusual entity is crucial for timely diagnosis and successful surgical management.
Lugata et al. (Wed,) studied this question.