Cervical fibroids: A diagnostic and operative challenge

Cervical fibroids are uncommon––constituting 1-2% of fibroid cases––and present with an array of symptoms that can mimic other conditions such as large cervical polyps, incarcerated procidentia, chronic uterine inversion, and cervical cancer. 

The goal of a recent study was to analyze 24 cases of cervical fibroids.

This retrospective study was conducted over two years at the Obstetrics and Gynecology Department of PGIMS, Rohtak.

The findings revealed that 75% of women experienced vaginal bleeding, with 44.6% reporting heavy menstrual bleeding, 33.3% having irregular bleeding, and one case involving postmenopausal bleeding. Urinary symptoms were present in 41.6% of cases, while 16.6% had difficulty with stools, and 8.3% were diagnosed with leiomyosarcoma. Vaginal discharge was rare, affecting only 1.5% of women. There was no distinct symptom pattern to differentiate between anterior and posterior fibroids. The results also depicted that an increase in the mass of cervical fibroids was associated with malignancy development, as well as bladder and intestinal issues. Meanwhile, severe anemia and vaginal bleeding were not directly linked.

Cervical fibroids are generally benign and can occur at any age. Their atypical presentation makes diagnosis challenging. The most common symptoms are vaginal bleeding and urinary retention.

Central and supravaginal fibroids are particularly difficult to operate on. Preoperative imaging and careful intraoperative assessment of pelvic anatomy are crucial for effective management and to anticipate potential complications. Intracapsular enucleation is recommended to avoid ureteric injury. Given the potential for malignancy, especially in large fibroids, it is important to consider the possibility of hidden cervical cancer before surgery.

Source: Dahiya S, Dahiya P, Saini K, et al. Indian J Obstet Gynecol Res 2024;11(3):409-414