Abstract

Background Primary paraurethral tumours of benign nature in females are quite infrequent. Physical examination and imaging modalities like ultrasound and magnetic resonance imaging of the pelvis help in characterising the mass morphologically and structurally. They also help to decipher the relationship of the mass with the urethra and the vagina. Case A 51-year-old parous lady was referred to our urogynaecology clinic in view of a long standing vaginal lump. On examination, she had a 3 × 3 cm firm, nontender, mobile anterior vaginal mass with a smooth surface. The upper limit of the lump was about one cm below the urethral orifice. An ultrasound of the pelvis revealed a 3.1 × 2.5 × 1.5 cm well circumscribed hypervascular hypoechoic mass with a vascular pedicle at the region of the introitus. She was counselled for excision of the vaginal mass. Intraoperatively, a metal urethral catheter was inserted. A midline vertical incision was made over the mass and it was enucleated. A check cystourethroscopy performed was normal. The tumour bed and the vaginal mucosa were closed using vicryl sutures. Results The patient recovered well. The histopathology report revealed a smooth muscle tumour with epithelioid and spindle cells arranged in cords, nests and fascicles. Conclusion Epithelioid leiomyomas are very rare. Surgical excision and histopathologic examination is generally required to confirm the diagnosis and to exclude the presence of a sarcoma. Long term follow up is advised as late recurrences may occur.

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