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Cervical myoma simulating an ectopic pregnancy
CERVICAL
MYOMA
E. C. SITES, M.D., F.A.C.S.,
SIMULATING
AN ECTOPIC
F.I.C.S.,
PREGNANCY
J. J. COURY, M.D., AND J. A. BARS, PORT HURON, MICH.
(From ths Port Huron
M.D.,
Llospital)
HE location and shape of this cervical myoma and the symptoms presented a clinical picture of an ectopic pregnancy. It was impossible to rule out a cervical myoma without a pneumoperitoneum. T
Case Report This 4%year-old white woman was admitted to the chief complaint of abdominal pain and vaginal bleeding upset. The patient had regular menstrual periods of a period which was scanty and of a shorter duration. February 4. Three days prior to admission the patient associated with an elevated temperature. She had several prior to admission to the hospital she had a dark vaginal ing. This occurred 14 days after the last menses.
Fig.
Port Huron Hospital with the associated with an intestinal 26 day type except for the last The last menstrual period was had a diarrhea which was not episodes of vomiting. One day discharge with bright red bleed-
1.
On admission the temperature was 98.5” F., and the blood pressure was 140/90. Marked tenderness was present in the right lower quadrant. Pelvic examination showed the vagina to be full of dark and bright red blood. The uterus was approximately of normal size. In the right adnexa there was a 3 cm. rather irregular tender mass, which 221
222
8ITE8,
COURT,
ASD
B12RSS
Am. J. obsr.
B
Gynec.
lanl;.llv,
1956
seemed to move with the uterus. The left adnexa were normal. A presumpt,ive diagnosis of right estopic pregnancy was made. The laboratory reports showed a trace of albumin: erythrocyte count 4.3 million; leukocyte count 5,500; hemoglobin 12.5 Gm. per iii!) ml.; total polymorphonuclear leukocytes 79, of which 14 were stab cells and 65 segmented cells, 20 lymphocytes, and 1 eosinophil. The frog pregnancy test was reported negati;r’. Prior to operation, the patient was re-examined under anesthesia and a right :tdnexal mass as previously described was found but it was impossible to outline or determine the exact character of this mass. At operation the abdominal viscera mere explored and mere found to be negative. There were a myomn on the anterior surface of the ut<,rns and a mass extending into the broad ligament above the ut,rrosacral ligament. This mass was firm and adherent, and a diagnosis of a cervical allenomyoma P~RY made at thi? st.age of the operation. Tn view of the presence of anotller m:-oma o hystereetomwas pcrformetl. The patient had a normal postoperative course and was discharged on the -uillth pnstoperative day. Fig. 1 illustrates the right adnexa! mass. uterus with i121 if~traI~gi~Pathologicnl Eeport.-The specimen consisted of a total mentary pedunculated cervical myoma 3.5 cm. al,uve 1110 c~xtrrnal OS and a W,I O~UX {vu the anterior surface of the uterus. The attached pedunculated myoma measured 4 11) 2.5 cm. and had a dark congested bluish white color. ~~icroscopic sections of the tlrIr!l~r ,.iia\cerl a fibromyoma.
Summary 11 case is reported of an intraligamentary cervical myoma which, of its location, contour, and the physical findings, made it difficult rule out an ectopic pregnancy. account
301 MICHIGAN NATIONAL BANK BUILDING 802 MILITARY STREET
on
to
MYOMA
E. C. SITES, M.D., F.A.C.S.,
SIMULATING
AN ECTOPIC
F.I.C.S.,
PREGNANCY
J. J. COURY, M.D., AND J. A. BARS, PORT HURON, MICH.
(From ths Port Huron
M.D.,
Llospital)
HE location and shape of this cervical myoma and the symptoms presented a clinical picture of an ectopic pregnancy. It was impossible to rule out a cervical myoma without a pneumoperitoneum. T
Case Report This 4%year-old white woman was admitted to the chief complaint of abdominal pain and vaginal bleeding upset. The patient had regular menstrual periods of a period which was scanty and of a shorter duration. February 4. Three days prior to admission the patient associated with an elevated temperature. She had several prior to admission to the hospital she had a dark vaginal ing. This occurred 14 days after the last menses.
Fig.
Port Huron Hospital with the associated with an intestinal 26 day type except for the last The last menstrual period was had a diarrhea which was not episodes of vomiting. One day discharge with bright red bleed-
1.
On admission the temperature was 98.5” F., and the blood pressure was 140/90. Marked tenderness was present in the right lower quadrant. Pelvic examination showed the vagina to be full of dark and bright red blood. The uterus was approximately of normal size. In the right adnexa there was a 3 cm. rather irregular tender mass, which 221
222
8ITE8,
COURT,
ASD
B12RSS
Am. J. obsr.
B
Gynec.
lanl;.llv,
1956
seemed to move with the uterus. The left adnexa were normal. A presumpt,ive diagnosis of right estopic pregnancy was made. The laboratory reports showed a trace of albumin: erythrocyte count 4.3 million; leukocyte count 5,500; hemoglobin 12.5 Gm. per iii!) ml.; total polymorphonuclear leukocytes 79, of which 14 were stab cells and 65 segmented cells, 20 lymphocytes, and 1 eosinophil. The frog pregnancy test was reported negati;r’. Prior to operation, the patient was re-examined under anesthesia and a right :tdnexal mass as previously described was found but it was impossible to outline or determine the exact character of this mass. At operation the abdominal viscera mere explored and mere found to be negative. There were a myomn on the anterior surface of the ut<,rns and a mass extending into the broad ligament above the ut,rrosacral ligament. This mass was firm and adherent, and a diagnosis of a cervical allenomyoma P~RY made at thi? st.age of the operation. Tn view of the presence of anotller m:-oma o hystereetomwas pcrformetl. The patient had a normal postoperative course and was discharged on the -uillth pnstoperative day. Fig. 1 illustrates the right adnexa! mass. uterus with i121 if~traI~gi~Pathologicnl Eeport.-The specimen consisted of a total mentary pedunculated cervical myoma 3.5 cm. al,uve 1110 c~xtrrnal OS and a W,I O~UX {vu the anterior surface of the uterus. The attached pedunculated myoma measured 4 11) 2.5 cm. and had a dark congested bluish white color. ~~icroscopic sections of the tlrIr!l~r ,.iia\cerl a fibromyoma.
Summary 11 case is reported of an intraligamentary cervical myoma which, of its location, contour, and the physical findings, made it difficult rule out an ectopic pregnancy. account
301 MICHIGAN NATIONAL BANK BUILDING 802 MILITARY STREET
on
to