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Vaginal Polypoid Endometriosis Simulating Neoplasia in a Young Woman

Dadhwal, Vatsla MD1; Deka, Dipika MD1; Mathur, Sandeep MD2; Kaushal, Seema MD2; Sharma, Aparna K. MD1; Mittal, Suneeta MD1

Journal of Lower Genital Tract Disease: July 2012 - Volume 16 - Issue 3 - p 318–321
doi: 10.1097/LGT.0b013e318241052b
Case Reports

Objective: The study aimed to describe a case of vaginal polypoid endometriosis and its management.

Materials and Methods: This study is a case report. The patient was a nulliparous woman aged 27 years who presented with pain in her lower abdomen and continuous bleeding per vaginum for 2 months. On speculum examination, multiple, smooth, polypoid masses were seen arising all around the vaginal fornices; cervix was healthy. Ultrasound revealed a bulky uterus with a 5 × 6-cm fibroid in the posterior wall with echogenic area adjacent to cervix and gross left hydroureteronephrosis. The right kidney was removed 6 years consequent to pyonephrosis. Biopsy of the vaginal polypoidal mass was reported as vaginal polypoid endometriosis. The patient was planned for myomectomy and vaginal mass excision. On examination under anesthesia, the base of polypoid mass was thick and fixed and could not be excised completely. Myomectomy was done. Postoperatively, the patient received 3 injections of gonadotropin-releasing hormone agonist, but the size of the mass did not decrease. She was then planned for ureteric reimplantation and panhysterectomy. Hysterectomy was not possible because of extensive parametrial involvement, but Boari flap ureteric implantation with bilateral salpingo-oophorectomy was done.

Results: Vaginal polypoid endometriosis did not respond to medical treatment. However, the widespread vaginal polypoidal masses regressed significantly after oophorectomy.

Conclusion: Bilateral oophorectomy was resorted to as an option in this case of vaginal polypoid and extensive pelvic endometriosis not amenable to medical treatment and surgical excision.

Vaginal polypoid endometriosis, a rare kind of endometriosis, can simulate a tumor.

Departments of 1Obstetrics and Gynaecology, and 2Pathology, All India Institute of Medical Sciences, New Delhi, India

Reprint requests to: Vatsla Dadhwal, MD, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029. E-mail: vatslad@hotmail.com

The authors have no conflicts of interest or disclosures.

©2012The American Society for Colposcopy and Cervical Pathology