Open Journal of Obstetrics and Gynecology, 2011, 1, 221-224
doi:10.4236/ojog.2011.14043 Published Online December 2011 (http://www.SciRP.org/journal/ojog/
OJOG
).
Published Online December 2011 in SciRes. http://www.scirp.org/journal/OJOG
Cavernous hemangioma of the cervix and pregnancy:
a case report
Samar Elkhateb1,2*, Mostafa Azzouzi Idrissi2, Kamilia Laabadi1,2, Leila Chbani2,3, Hikmat Chaara1,2,
AbdIlah Melhouf1,2
1Department of Gynaecology and Obstetrics II, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco;
2Sidi Mohamed Ben Abdullah University, Fez, Morocco;
3Department of Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdullah University, Fez, Morocco.
Received 5 June 2011; revised 24 July 2011; accepted 10 August 2011.
ABSTRACT
Purpose: Cavernous haemangiomas of the uterine cer-
vix are very rare and usually harmless. It is a benign
tumor that may cause gynecological obstetrical com-
plications. Although it is a benign condition but it can
have serious consequences for the mother as well as
for the baby. The treatment is often surgical and dia-
gnosis is histological. Methods and Result: we repor-
ted a case of cavernous haemangioma of the cervix in
a 25-year old multiparous patient, referred to our
Centre in the 33 - 34 gestational weeks for premature
labor with membranes rupture. A 3 cm × 6 cm soft
regular purplish red mass is found in the uterine cer-
vix. Tocolosys, prophylactic antibiotic therapy and
corticotherapy for fetus pulmonary maturation were
then decided after elimination of chorioamniotite si-
gns. Caesarean has been made during labor, a week
later, for tumor previa. The tumor excision has been
made through the vagina after fetus extraction. The
histological examination confirmed diagnosis of the
cavernous haemangioma. Discussion: Further to this
observation, the clinical, histological and therapeutic
characteristics of the cavernous haemangioma unu-
sual presentation were drawn up and literature enri-
ched since this pathology is rare. Most previous repor-
ts in the literature consist of single-case histories, and
the experience of individual institutions is limited. The
patients dramatically present dilemmas in the disease
management. This can result in uncontrolled bleeding
especially during operative delivery and may require
hysterectomy. To avoid unexpected bleeding from hae-
mangioma, patient s should be repeatedly examined for
haemangioma of the birth canal, and special care shou-
ld be taken in choosing the delivery mode.
Keywords: Cavernous Haemangioma; Uterine Cervix;
Pregnancy; Tocolytic Therapy
1. INTRODUCTION
Cavernous haemangioma of uterine cervix is a rare vas-
cular malformation. It is a benign pathology. Its seat is
primarily visceral and generally hepatic [1,2-4]. This
cervical lesion may cause vaginal metrorrhagia or pains
[1,2-9]. It seems that the tumor can vary. The different-
tial diagnosis includes a cervical malignant tumor. The
anatomopathologic study proves the benign and vascular
nature of the tumor [10]. The treatment is generally sur-
gical [1,2]. Many gynecological and/or obstetrical com-
plications are often associated. The gynecological com-
plications are inter-menstrual spotting, menometrorrha-
gia, post-menopause metrorrhagia, post coitus metrorr-
hagia, infertility and dyspareunia [1-2,7-9]. The obstet-
rical complications are the premature rupture of mem-
branes, the fetal death in the uterus, the postpartum hae-
morrhage and disseminated intravascular coagulation
[3-5,11-13]. The dilemma that may arise is the delivery
way in a pregnant mother having a cervical cavernous
haemangioma [3-17]. In this report, we describe a hae-
mangioma of the uterine cervix in a 25-year old multi-
parous patient, who presented premature labor with me-
mbranes rupture in the 33 - 34 gestational weeks. Caesa-
rean has been made during labor, a week later, for tumor
previa. The tumor excision has been made through the
vagina after fetus extraction. The histological study con-
firmed diagnosis. Apparently, the reported case empha-
sizes the importance of special care in the choice of the
delivery mode. This case is presented in order to increa-
se awareness on the existence of Cavernous haeman-
gioma of the uterine cervix during pregnancy, which
may cause life-threatening bleeding at the delivery time
and obstetrical complications.

S. Elkhateb et al. / Open Journal of Obstetrics and Gynecology 1 (2011) 221-224 222
2. CASE REPORT
Mrs. S.Z, 25 year-old, multiparous, G6 P2 1EV with two
late abortions, referred to our Centre for premature rup-
ture of the membranes at eight-month pregnancy. The
clinical examination objectivized a 3 cm × 6 cm soft re-
gular purplish red mass, overhanging through the vulva.
At the vaginal touch, this formation expands to the cer-
vix anterior lip. At the obstetrical examination, several
parameters are found: The fundal height at 26 cm, Fetal
Heart Beat, beginning uterine contractions associated to
modifications in the uterine cervix and Bishop scores
less than or equal to 4. An obstetrical ultrasonography e-
valuated the pregnancy at the 34th week of amenorrhea
with the fetus weight estimated at 2508 grams. The ma-
turity signs are absent and placenta is localized on the
anterior fundic wall. Nifedipine tocolysis, prophylactic
antibiotic therapy and antenatal corticosteroids for fetal
lung maturation were then decided after elimination of
Chorioamniotic signs. One week later, the patient ente-
red in the active phase of labor. A caesarean was decided
because of the previa obstacle. The new born child is a
female premature, at 33 weeks - 34 weeks of amenorrhea,
Apgar score at 8/10, with a birth weight of 2350 g. After
fetus extraction, the tumor excision, at the edge of the
cervix, through the vagina was carried out (Figur e 1).
The anatomopathological study of the piece revealed
the cavernous haemangioma. The Histological analysis
detects a benign tumor growth, without normal cervical
stroma, made up from vascular grooves, of various sizes,
full of blood. The walls of these grooves are very fine,
composed of regular and flattened endothelium, and re-
sting directly on neighboring fibrous tissue (Figure 2).
Figure 1. Soft regular purplish-red mass overhanging through
the vulva.
Figure 2. Fibrous tissue containing large cavities filled with
blood and lined by regular endothelial cells.
3. DISCUSSION
The uterine cervix cavernous haemangioma is a vascular
benign tumor growth primarily made up of superficial
and/or deep dilated large blood-vessels. It can touch
many internal organs such as the liver, the spleen, the
pancreas, the gastrointestinal tract, the skin, the uterus
and sometimes the brain. The cervical localization is rare
[1-12]. In Table 1, we present 15 cases found in the lite-
rature. 5 cases are associated with pregnancy besides our
case (Table 1).
Most cases in these series presented post-coitus met-
rorrhagias that were regarded as endocervical polyp in
the clinical examination. These lesions were suspected to
be malignant tumors at vaginal touch. Although the ute-
rine cervix haemangioma is generally asymptomatic [7],
35% of the reported cases were associated to vaginal
bleedings (menometrorrhagia, post-coitus metrorrhagia)
[8,18-20]. Changes during pregnancy under hormonal
influence can present a risk of obstetrical complications
[8-13]. A quick growth of the lesion, during pregnancy,
may generate premature rupture of membranes, prema-
ture Labor, fetal death in-utero, postpartum haemorrhage
and disseminated intravascular coagulation [20]. These
complications require delivery by Caesarean [13-17].
Surgical excision is curative in most of cases. Because
the haemangioma is a benign vascular lesion with a high
hemorrhagic risk, conservative therapies have been sug-
gested such as the use of sclerosing agents, cryotherapy,
and CO2 laser excision (carbon dioxide laser) [8]. The
cervical haemangioma that especially presents serious
complications, can be treated by local excision, conisa-
tion, or through ablation by laser [9-10]. These therapeu-
tic methods permit to preserve fertility in the young
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Table 1. Review of various cases of the uterine cervix cavernous haemangioma in the literature.
Ahern [18] 1978 Patient found to have cervical haemangioma on ultrasound, managed in a conservative way.
Jackson [12] 1993 Cervical haemangioma is diagnosed in an asymptomatic multiparous woman or during pregnancy,
expectant management is warranted.
Petry [11] 1994 31-year old multiparous woman in the 34 + 1 gestational week, who presented herself with a fast growing
cervical haemangioma, indicates that this benign tumor may cause obstetrical complications.
Padmanabhan [19] 2001 Oral Contraceptive Pills related cervical haemangioma and focal nodular hyperplasia of the liver.
Riggs [20] 2003 Patient presented intractable bleeding after Medical termination of pregnancy. Required hysterectomy
on Histopathology-cavernous haemangioma.
Kondi-Pafiti [10] 2003 9 unusual vascular tumors of the female genital tract and to investigate the problems in the differential diagnosis from
other genital lesions. A capillary haemangioma of the endometrium, one capillary and one cavernous haemangioma
of the cervix, 6 vulva lesions (one capillary, and one cavernous haemangioma and 4 angiokeratomas) and one
haemangiosarcoma of the mons pubis in a 76-year-old patient were diagnosed. The differential diagnosis of the
vascular tumors must be made mainly from endometriotic lesions and melanomas. Immunohistochemistry
(S-100, CD31, CD34, CKS, EMA) aid in the Diagnosis. Local excision is appropriate for the benign vascular lesions.
Baxi [7] 2005 Haemangioma of the cervix was found in a 60-year-old female patient with prolapse of uterus. The haemangioma
was incidentally detected during routine histopathological examination of the organ removed by surgery.
Wang [9] 2005 Examination of a 39-year-old patient presenting pelvic pain revealed a noticeable pelvic mass consisting of a 10 c
m
tumor extending from the cervix to the retro peritoneum. The pathology report demonstrated spindle cell
haemangioma. This is a rare case of spindle cell haemangioma of the cervix after transvaginal resection.
Ozyer [8] 2006 Reported a case of cavernous haemangioma of the cervix in a 53-year-old patient complaining about
postcoital spotting.
Tanaka [17] 2007 The Patient has BRBNS, haemangioma of the uterine cervix appeared during pregnancy.
Caesarean section was performed without complications, One month after delivery,
cervical haemangiomas were found to have decreased in size.
El Khateb 2008 25-year old multiparous patient in the 33 - 34 gestational week for premature labor with membranes rupture. A 3 cm
× 6 cm soft regular purplish red mass is found in the uterine cervix. Caesarean has been made for
tumor previa interference. The tumor excision has been made through the vagina after caesarean.
Reggiani Bonetti [6] 2009 3 cases of haemangioma of the cervix in asymptomatic women, diagnosed as cavernous haemangioma. All
tumors were immunoreactive for CD31, CD34, and factor-VIII-related antigen. Focal expression of
estrogen receptors was detected. No positivity was obtained with progesterone receptor antibodies.
The presence of estrogen receptor in the endothelial cells of the haemangioma of the cervix suggests
a direct role of this hormone in the haemangioma development. A possible target therapy is discussed.
female patients [1-5]. The surgical excision has always
been essential to eliminate a subjacent malignant tumor,
including malignant vascular lesions [10]. In gyneco-
logical practice, the embolization treatment for arterio-
venous malformations was crowned with success in pa-
tients presenting serious menorrhagia with relief of sym-
ptoms and preservation of their capacity of reproduc-
tion [14]. However, the cervical haemangioma can be
treated, if necessary, by hysterectomy [15,18,20]. Spon-
taneous regression of the lesion has been reported by
Tanaka et al. [17].
The uterine cervix cavernous haemangioma is a rare
lesion given its localization. The diagnosis of this benign
tumor is histological. It is purely morphological and
does not require any complementary technique. As in the
case of other localizations, lesions are large-sized, less
marked-out and often invading the underlying structures.
They are inclined not to regress and require thus a sur-
gical treatment to avoid bleedings, which are often fre-
quent and sometimes important. In Histology, they are
composed of dilated vessels, full of blood and lined with
regular endothelial cells, without atypical mitoses. The
vascular walls are sometimes thickened with adventitial
fibrosis. Calcifications may also be present. The differ-
rential histological diagnosis can be made if there is a
benign lesion having a vascular component of reactional
nature like the pyogenic or botryomycosis granuloma.
However, the lesion polyploidy aspect, its lobule well
marked-out character and the presence of abundant in-
flammatory infiltrate plead in favor of the reactional
nature of the lesion [10-16].
The cervical cavernous haemangioma can also be
found in particular cases of generalized vascular mal-
formations such as Blue rubber bleb nevus syndrome
(BRBNS), which is a rare disease showing venous mal-
formations on the skin, on the gastro-intestinal tract and
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S. Elkhateb et al. / Open Journal of Obstetrics and Gynecology 1 (2011) 221-224 224
on other internal organs. Norifumi Tanaka reported the
case of a patient who presented the BRBNS disease with
the outbreak of several haemangiomas on the uterine
cervix during pregnancy. A Caesarean was carried out.
One month postpartum reduction in the size of the le-
sions was observed. The lesion, induced by pregnancy,
increased during pregnancy and regressed after delivery
[17].
Padmanabhan et al. reported the rare association of ca-
vernous haemangioma of the cervix with the focal no-
dular hyperplasia of the liver in a patient using oral con-
traceptives [19].
Reggiani L et al. present three cases of cervix hae-
mangioma in asymptomatic women, diagnosed as ca-
vernous haemangioma in two cases and capillary hae-
mangioma in one. All tumors were immune-reactive to
CD31, CD34, and factor-VIII-related antigen. Focal ex-
pression of estrogen receptors was detected. No positivi-
ty was obtained with progesterone receptor antibodies.
The presence of estrogen receptor in the cervix haeman-
gioma endothelial cells suggests a direct role of this hor-
mone in haemangioma development. A possible target
therapy is discussed [6].
4. CONCLUSIONS
The uterine cervix cavernous haemangioma is a very
rare pathology in pregnant women. This benign vascular
lesion may cause gynecological-obstetrical complica-
tions. It is recommended to perform a Caesarean. Some-
times, the consequences could also be serious. Although,
delivery by natural ways is possible but Caesarean is
recommended. The differential diagnosis is very difficult
because it is a rare lesion. Uterine atony or disseminated
intravascular coagulation can be observed, likely to lead
to hysterectomy. The final diagnosis can only be made
via the histological study.
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