Presentation
A growing, painless vaginal mass over a 7-week period. Dyspareunia and pressure symptoms.
Patient Data
The MRI pelvis shows a large solid mass centered on the right side of the vagina, which measures 62 x 60 x 69 mm. It is of low signal on T2 with some high signal change centrally which is taken to be fluid. It is of low signal on T1, the solid component enhances avidly post-contrast. No blood or fat is seen within the mass.
It is inseparable from the right pubococcygeus muscle/inferior aspect of the levator ani.
Angiography was performed via a right femoral artery puncture. Selective angiograms showed a single IIA branch supplying the vaginal mass.
This vessel was catheterized with Progreat microcatheter and then embolized with 300-500 micrometers of polyvinyl acetate (PVA) particles and one 3/2 micro tornado coil.
The vaginal mass excision procedure was then initiated.
Histology report confirming a histological diagnosis of genital angiofibroma.
Case Discussion
Vaginal wall masses are rare lesions, usually arising from the anterior vaginal wall. The differentials range from benign and malignant tumors to urethral diverticulum, cystocele, or skene duct abscesses.1
There are no established guidelines as a result of the low incidence, but the general consensus recommends excision and histology examination to determine further clinical management.1
Vaginal wall masses are considered a rare entity, along with the unknown histology and nature of the mass, it necessitated a multidisciplinary approach of radiologists, interventionists, anesthesiologists, gynecologists and theater team in a dedicated interventional radiology theater, where imaging would roadmap the surgical approach, and the interventionist would reduce intraoperative blood loss. This was achieved through fluoroscopy-guided embolization of the IIA uterine artery branch via a US-guided common femoral artery puncture.
Surgical enucleation of the vaginal mass was conducted with ease and minimal blood loss. The patient was discharged as a day case. The histology confirmed a benign cellular angiofibroma.
Acknowledgement and many thanks for:
- Dr Peter Kember, Consultant Radiologist, Torbay hospital.
- Mr Manpreet Singh, Consultant Onco-Gynecologist, Torbay Hospital.
For all their help and support.