|Year : 2014 | Volume
| Issue : 2 | Page : 146-148
Leiomyoma of the female urethra: A rare presentation of a common tumour in a uncommon site
Nabaneet Majumder, V. Dafle, S. Patil
Department of Pathology, DY Patil Medical College, Kolhapur, Maharashtra, India
|Date of Web Publication||20-May-2014|
Department of Pathology, DY Patil Medical College, Kolhapur, Maharashtra
Source of Support: None, Conflict of Interest: None
Leiomyoma of the female urethra is a rare benign neoplasm arising from the smooth muscles. Here, we report a case of 60 year old female patient presented with pain in the abdomen and dysuria for 2 months. On cystoscopy, external urethral meatus normal. A large, non-pedunculated tumor arising from left lateral wall of urethra extending from bladder neck up to the proximal end of the external urethral meatus. The mass was excised and submitted for histopathological examination. Histology reveals leiomyoma.
Keywords: Female, leiomyoma, urethra
|How to cite this article:|
Majumder N, Dafle V, Patil S. Leiomyoma of the female urethra: A rare presentation of a common tumour in a uncommon site. J Sci Soc 2014;41:146-8
| Introduction|| |
Leiomyomas are benign tumors of smooth muscle origin and are rarely found in the urinary tract. , Originating from the smooth muscles, leiomyoma is the most common tumor in the uterus and rarely it arises from smooth muscles in the kidney, the bladder and very rarely from the urethra.  Here we reported a rare case of benign leiomyoma of the female urethra.
This was a case report of a 60-year-old woman presented with lower abdominal pain, dull aching in nature, mainly in suprapubic region along with dysuria for 2 months. There was no history of straining, intermittency or incomplete voiding. No history of increased frequency of micturition or voiding. On examination per abdomen was normal. No organomegaly. Suprapubic tenderness present. On local examination, external urethral meatus appeared normal. On cystoscopy, external urethral meatus normal. A large, non-pedunculated tumor arising from left lateral wall of urethra extending from bladder neck up to the proximal end of the external urethral meatus. The tumor was globular, uniform and the overlying mucosa showing hypervascularity. The urethra appeared slit-like due to occlusion by the tumor. The urinary bladder appeared normal. Resection of the tumor was done with resectoscope and the tumor was completely resected. During resection, the tumor appeared fibromuscular and was submitted for histopathological examination. Histology revealed a tumor composed of spindle-shaped smooth muscle fibers arranged in a whirling pattern and in fascicles and bundles [Figure 1]. Subsequently, immunohistochemistry was done which showed smooth muscle actin and desmin positivity, thus confirming our histology diagnosis [Figure 2] and [Figure 3]. Follow-up to 8 months was possible and there was no evidence of any recurrence or any local complications.
|Figure 1: Microphotograph showing benign spindle-shaped cells in interlacing fascicles and bundles (H & E, ×10)|
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|Figure 2: Microphotograph showing smooth muscle actin positivity of the spindle-shaped cells on immunohistochemistry (IHC, ×10)|
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|Figure 3: Microphotograph showing desmin positivity of the spindle-shaped cells on immunohistochemistry (IHC, ×10)|
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| Discussion|| |
Leiomyoma of the urethra is a rare condition and only 40 cases were reported. Women are more affected than males and the tumor is most common in 3 rd and 4 th decade; the mean age of the appearance is around 41 years. , Its origin is yet unknown. It is known that ovarian hormones favor its development, but it is difficult to say how exactly these hormones affect the development of the tumor, as there are documented cases even in post-menopausal women.  Anterior segment of the urethra can be affected but proximal segment is the most common site.  Common presenting symptoms include urinary tract infection, dyspareunia, urinary retention, urethral bleeding and irritative lower urinary tract symptoms. ,, The tumor has been reported to accelerate during pregnancy suggesting a possible hormonal dependence. , These tumors are classified as:
- Cutaneous leiomyoma (leiomyoma cutis) the most common group.
- Angiomyomas (vascular leiomyomas) are distinctive, painful and subcutaneous tumors composed of conglomerate of thick walled vessels associated with smooth muscle tissue.
- Leiomyomas of deep soft tissue these tumors are larger than their superficial counter parts, usually display a greater spectrum of histological changes and must be clearly distinguished from leiomyosarcomas, which are statistically more common in deep soft tissue.
Histology revealed a tumor composed of spindle-shaped smooth muscle fibers arranged in interlacing fascicles and bundles. No atypical mitosis, pleomorphism, hemorrhage and necrosis were noted.
The differential diagnosis is from a urethrocele, a urethral diverticulum and urethral malignancy. , A leiomyoma is distinguished from first two of them by careful clinical examination, cystourethroscopy and radiology of lower urinary tract.  However, only histopathological examination can distinguish it from malignancy.
IHC staining employing specific, monoclonal, anti-smooth muscle antibody confirms the smooth muscle origin of the neoplasm. Leiomyomas do not recur or metastasize with the exception of the rare metastasizing leiomyomas of the uterus and there are no reasons to believe that urethral leiomyomas behave in a different way. Until date no urethral leiomyoma has been reported to be recurred or metastasized. Simple surgical excision is the recommended treatment. Prognosis is excellent as recurrence or malignant transformation has not been reported. Local surgical excision is the treatment of choice of leiomyoma of urethra. 
| Conclusion|| |
Here we report a rare case of leiomyoma of urethra. Surgical excision is the treatment of choice. No recurrence and malignant transformation has been reported.
| References|| |
|1.||Jalde DD, Godhi SA, Uppin SM, Chako SP, Agrawal AM. A case of urethral leiomyoma A rare presentation. World J Sci Technol 2012;2:27-8. |
|2.||Pahwa M, Saifee Y, Pahwa AR, Gupta M. Leiomyoma of the female urethra-a rare tumor: Case report and review of the literature. Case Rep Urol 2012;2012:280816. |
|3.||Shilpa MN, Patil MA, Sunila S, Chandrashekhar AP. Usual tumor at an unusual site - A leiomyoma masquerading as a urethral polyp. Online J Health Allied Sci 2012;11:16. |
|4.||Senthil Kumar S, Sankar RG, Viswanathan P, Tippoo R, Ali A. "Urethral leiomyoma - A very rare entity". J Evol Med Dent Sci 2013;2:9077-80. |
|5.||Neeli SI, Alur SB, Kadli SU, Patne PB. Urethral leiomyoma in females: Report of 3 Cases. Uro Today Int J 2011;4. |
|6.||Jain R, Sawhney S, Bandhu S, Seth A. Leiomyoma of the female urethra. Indian J Radiol Imaging 2000;10:159-60. |
[Figure 1], [Figure 2], [Figure 3]