|Year : 2016 | Volume
| Issue : 7 | Page : 16-17
Cavernous hemangioma of the uterine cervix: A rare finding at colposcopy
Olabode Peter Oluwole1, Olatunde Onafowokan2, Godwin Otuodichinma Akaba2
1 Department of Pathology/Forensic Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
2 Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
|Date of Web Publication||28-Jul-2016|
Olabode Peter Oluwole
Department of Pathology/Forensic Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja
Source of Support: None, Conflict of Interest: None
Cavernous hemangiomas of the uterine cervix are quite rare. They are benign tumors that may cause gynecological or obstetrical complications. Although they can be found at all levels of the uterine wall, including the serosa, myometrium, and endometrium, there have been few cases reported from the uterine cervix. We report the case of a 22-year-old female with incidental finding of cavernous hemangioma of the uterine cervix following histopathological examination of tissues from a loop electrosurgical excision procedure during colposcopy.
Keywords: Cavernous hemangioma, colposcopy, uterine cervix
|How to cite this article:|
Oluwole OP, Onafowokan O, Akaba GO. Cavernous hemangioma of the uterine cervix: A rare finding at colposcopy. N Niger J Clin Res 2016;5:16-7
| Introduction|| |
Hemangiomas of the uterus are rare as only a few cases have been reported in the literature.  The occurrence of this vascular lesion on the uterine cervix is even rarer. 
Majority of the time, they occur as incidental findings due to their small size and asymptomatic nature but may also present with clinical symptoms such as abdominal pain, abnormal vaginal bleeding, anemia, infertility as well as pregnancy-associated complications such as postpartum hemorrhage. ,
| Case Report|| |
A 22-year-old para 1+0, 1 alive presented to the family planning clinic for routine checkup because she had intrauterine contraceptive device (IUCD) inserted for her about a year before presentation. She had complained of occasional contact bleeding. There was no history of irregular vaginal bleeding, abnormal vaginal discharge, or abdominal pains. She menstruated for 4 days in regular cycles of 28 days, and there was no history of menorrhagia.
Her last childbirth was about 2 years before presentation, and there were no complications. She had IUCD inserted for her a year after her delivery and she had been regular with her follow-up visits.
On speculum examination, the cervix was parous and the IUCD string was visible. There was no contact bleeding, growth, or lesion visible on the cervix, but the cervix was hyperemic with granular areas on both lips. A clinical impression of chronic cervicitis with high index of suspicion for a high-grade premalignant lesion of the cervix was made.
She was immediately scheduled for colposcopy which was available in the family planning clinic. Colposcopic examination showed a Type 1 transformation zone, there was increased vascularity on green filter, no mosaic pattern was seen, but there were dense acetowhite and iodine sparing areas on both lips of the cervix. A diagnosis of cervical intraepithelial neoplasia III was made. She had loop electrosurgical excision procedure, and the tissue was sent for histology.
The microscopic examination report revealed numerous koilocytic atypia with mild dysplasia of the ectocervix that overlies numerous cystically dilated vascular channels containing red blood cells with extravasated hemorrhage and fibrin. There were nabothian cysts with periglandular moderate inflammation and focal areas of early squamous metaplasia. The appearance was consistent with cavernous hemangioma of the cervix [Figure 1].
|Figure 1: Section of the cervix showing medium-size cystically dilated vascular channels filled with red blood cells and infiltrated by few lymphocytes (H and E, ×40)|
Click here to view
She subsequently had two follow-up visits and remained without any complaints a year after the loop electrosurgical excision procedure (LEEP) procedure.
| Discussion|| |
Cavernous hemangioma of the uterine cervix is usually asymptomatic as was seen in this patient who presented for routine follow-up visit at the family planning clinic with no significant complaint except for history of contact bleeding which was not taken seriously by her. When it is symptomatic, patients usually present with abnormal vaginal bleeding which may be intermenstrual, postmenopausal, or postcoital bleeding. , Other presentations include dyspareunia or as a cervical mass. , Careful examination and high index of suspicion are therefore essential toward making a diagnosis of this rare vascular lesion of the uterine cervix. The tumor is said to be more common in the second and third decades of life. ,, As was the case in our patient, this condition has also been reported in postmenopausal women and should be considered as a differential diagnosis in women with abnormal vaginal bleeding in this subpopulation. ,
Investigative aids include the use of transvaginal ultrasonography, magnetic resonance imaging, and computerized tomography scan, but these were not done as the diagnosis was not initially suspected.  However, the findings at colposcopy heightened the suspicion when there was increased vascularity of the cervix on the green filter.
Management options include conservative approaches such as carbon dioxide laser excision, knife excision, cryotherapy, radiotherapy, electrocauterization, internal artery ligation, uterine artery embolization, local excision, conization, and laser ablation. , She had LEEP which is a form of electrocauterization. Conservative approach was used for her treatment because it was an incidental finding; she did not have the complication of uncontrollable vaginal bleeding, and she has remained asymptomatic a year after the LEEP procedure.
| Conclusion|| |
Although cavernous hemangioma of the uterine cervix is a rare condition, detailed attention by colposcopic examination of cervical lesions as well as histological examination of biopsy tissues may help in early detection and treatment of this rare lesion which could negatively impact on the quality of life of women.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Vijayakumar A, Srinivas A, Chandrashekar BM, Vijayakumar A. Uterine vascular lesions. Rev Obstet Gynecol 2013;6:69-79.
Djolai M, Boškovic T, Djurdjevic S, Dajko ST, Visnjic BA, Rajovic R. Hemangioma of uterine cervix associated with high-grade squamous intraepithelial lesion. Vojnosanit Pregl 2015;72:541-4.
Mahapatra S, Das BP, Kar A, Das R, Hazra K, Sethy SA. A carvenous haemangioma of the uterine cervix during pregnancy. South Afr J Gynaecol Oncol 2012;4:63-5.
Singh P, Swim R. Cavernous hemangioma of the uterine cervix treated with carbon dioxide laser ablation. J Gynecol Surg 2013;29:324-426.
Ustuner I, Bedir R, Ustuner P, Bagci P, Gucer H, Sehitoglu I, et al.
Clinical and histopathologic differential diagnosis of venous malformation of the uterine cervix. J Low Genit Tract Dis 2013;17:e22-5.
Kondi-Pafiti A, Kairi-Vassilatou E, Spanidou-Carvouni H, Kontogianni K, Dimopoulou K, Goula K. Vascular tumors of the female genital tract: A clinicopathological study of nine cases. Eur J Gynaecol Oncol 2003;24:48-50.
Benjamin MA, Yaakub HR, Telesinghe P, Kafeel G. A rare case of abnormal uterine bleeding caused by cavernous hemangioma: A case report. J Med Case Rep 2010;4:136.
Jung HR, Cho CH, Kwon SH, Young Kwon S. Cavernous hemangioma of the uterus in a postmenopausal woman - A case report. Korean J Pathol 2011;45:520-2.
Baxi S. Capillary haemangioma of the cervix - A case report. Indian J Pathol Microbiol 2005;48:373-5.