Transrectal dual-plane ultrasound with contrast enhancement in primary vaginal fibroma diagnosis: A case report
Rationale:
Superficial vaginal fibroblastoma (SCVM), a rare benign mesenchymal tumor, is notoriously challenging to diagnose due to its asymptomatic presentation and location. Typically seen on ultrasound as a well-defined, homogeneous, medium-echogenic mass with abundant vascularity, it is often missed by conventional transvaginal ultrasound (TVUS) with end-fire probes, which inadequately assess the vaginal canal. To address this, we employed a novel integrated approach using transrectal biplane ultrasound (TRBU) and contrast-enhanced ultrasound (CEUS). This strategy significantly advances the early and accurate diagnosis of vaginal fibromas.
Patient concerns:
A 54-year-old female with no obvious symptoms presented for evaluation of a vaginal wall mass detected during a routine physical examination.
Diagnosis:
TRBU revealed a 30 mm-diameter hypoechoic mass on the left vaginal wall. CEUS demonstrated a hyperperfused mass with a capsular appearance, which was presumed to be benign. The patient’s HPV test was negative, and laboratory investigations showed tumor markers within normal ranges.
Interventions:
The patient underwent vaginal lesion resection, which was confirmed histopathologically as a vaginal soft tissue fibrous tumor. Following pathological departmental discussion, the lesion was favored to be a vaginal superficial myofibroblastoma.
Outcomes:
The patient had an uneventful postoperative recovery, and telephone follow-up confirmed no evidence of recurrence to date.
Lessons:
This case highlights the essential role of combining TRBU and CEUS in diagnosing indeterminate vaginal masses. The high-resolution imaging of TRBU, complemented by the real-time quantitative microvascular perfusion data from CEUS, allows for a thorough and nuanced evaluation. This combined approach delivers critical insights for accurate diagnosis and subsequent surgical decision-making.