1. 초음파실 통계 OBGYhysteroDop 정밀정밀 양수양수 3D 합계 06.08.7- 08.12 7920201673298 06.08.14- 08.19 90168 3 1312268 11-34+30-3-6-30

2. GY case presentation ( 이 0 연 F/36) 가천의과대학 길 병원 산부인과 Sonographer : 안 소 영

3. - CC.: For evaluation of known vaginal mass. - P.I. : 내원 전일 삼성 Local clinic 방문, ant vaginal wall 에 3cm cystic mass 발견 further evaluation 위해 본원 내원. 이 0 연 ( 36/ F)

4. OB/HX :G(5) P(2) A (3) L(2) P/HX: THYROID CA OP. 10YRS. AGO C/section X2 D&EX3 no known allergy F/HX: father: throat ca. Menstrual history LMP:7/15/06 menarche(15) : interval:1mo. Duration:5days amount:normal flow 이 0 연 ( 36 / F)

5. Chest AP : normal EKG: normal PAP: normal 이 0 연 (36 / F)

6. Sono findings ( 06/8/1 ) * Ut. Position : RVF

7. * Uterus size: 7.3 X 4.5 X3.9 cm

8. * post: 1.1x1.3x0.8cm sized hypoechoic mass.

9. * RT.Ovary : 2.9 x 1.6 cm LT.Ovary : 3.2 x 1.4 cm

10. : 3.2x1.7cm sized anechoic cyst beside lt. ov.

11. : va. ant.wall: 2.9x3.3x2.4cm sized mixed echoic mass. color flow:(+) ant wall 에서 color flow:(+), RI: 0.62 trans labial sono: 4.1x3.4cm, echogenic wall.

16. Sono –IMP small myoma ut R/O lt. adnexa cyst R/O Lt. parov. cyst R/O Lt. tubal cyst R/O va. fibroid R/O suburethral diverticulum

17. OP Findings 06 / 8 / 7 Operation name : vag mass excision 3-4cm sized mass in ant.vag wall

18. 병리검사보고 Diagnosis Vagina, anterior, excision: Leiomyoma, 3.2x2.5x2.0cm Comment Results of immunohistochemistry: -Smooth muscle actin: positive - S-100 protein: negative

19. 1. Cyst - fibroepithelial polyp - epidermal inclusion cyst - Gartner’ duct cyst 2. Solid tumor – condyloma accuminatum - endometriosis - vaginal adenosis 3. Malignant tumor – primary vaginal cancer - Secondary carcinoma of vagina - Sarcoma of vagina - Melanoma - Germ cell tumor

20. The majority of leiomyomas arise from body of the uterus and sometimes from cervix. The extrauterine sites of this tumour are round ligament, uterosacral ligament, ovary, inguinal canal and very rarely vagina and vulva. Primary vaginal fibroids are very rarely encountered. Approximately 300 cases have been reported in world literature 1 Leiomyoma of the Vagina

21. The tumours were most commonly situated on anterior wall of vagina and varied from 1 to 3 Cm in diameter 2 In the vagina, leiomyoma usually presents as a solid single nodule mostly from anterior vaginal wall in women between 35–50 years of age 1

22. These rare lesions are benign, and symptoms, often absent during early stages, are due to compression from the growingtumor 7, depending on size and location of leiomyoma 4 Presentation can be as urinary symptoms like dysuria frequency, and urinary retention along with dyspareunia and pelvic pain 6

26. Anterior wall of vagina. - Cyctocele - Urethrocele - urethral diverticlum - Prolapse of uterus - cx. myoma Posterior wall of vagina - Rectocele - rectal tumor Lateral wall of vagina - Garner’ duct cyst - bartholin duct cyst

28. Ultrasonography usually diagnoses it to be a cervical fibroid. Magnetic imaging shows it as a homogenous lesion with signal similar to that of myometrium 6 Low back pain occurs due to pressure on the pelvic ligaments or lumbar plexus and dysuria due to pressure on the urinary bladder. Superiorly situated leiomyomas may involve the distal ureters, which can be assessed by intravenous urography. Large lesions may interfere with delivery.

29. Sarcomas represent 2–3% of all gynecologic malignancies however only 10% occur outside uterus. There are case reports of leiomyosarcoma of vagina. They are common in posterior wall of vagina 10