Hysteroscopic Resection of Cervical Nerve Sheath Tumor Robert S. Goldfarb, MD, Brent N. Davidson, MD JSLS ABSTRACT Isolated nerve sheath tumors of the uterine cervix are very rare entities. This is especially true for benign nerve sheath tumors. We present, to the best of our knowledge, the first case of a benign nerve sheath tumor resected hys- teroscopically. Our patient is a 69 year-old white female with a history of post menopausal bleeding. Initial workup included an endometrial biopsy and an ultra- sound. A 4 cm cervical mass was identified on that study. Further characterization of the mass was obtained with magnetic resonance imaging (MRI). Gynecologic- Oncology consultation was obtained, and the opinion was that this was a cervical myoma. The patient continued to have bleeding and was taken to the operating room for a hysteroscopy and dilatation and curettage. At surgery, a large cervical mass was resected hysteroscopically. Final pathology report showed this to be a benign nerve sheath tumor. Key Words: teroscopy. Nerve sheath tumor, Operative hys- Department of Obstetrics and Gynecology Henry Ford Health System Detroit, Michigan (all authors) Address reprint request to: Robert Goldfarb, MD, FACOG, Department of Obstetrics and Gynecology, Henry Ford Medical Center, 6777 West Maple, West Bloomfield, Michigan 48322, USA. INTRODUCTION Involvement of the uterine cervix by nerve sheath tumors, particularly benign nerve sheath tumors, is very uncommon. Such masses are difficult to diagnose as this is an unusual finding. We present, to the best of our knowledge, the first case of a benign nerve sheath tumor resected hysteroscopically. CASE REPORT A 69 year-old white female presented for evaluation of post menopausal bleeding. The patient had been bleed- ing for one week prior to presentation. She had no prior history of post menopausal bleeding and was not on any hormone therapy. Initial evaluation consisted of an endometrial biopsy, which showed inactive endometrium and blood. Due to morbid obesity, the pelvic exam was suboptimal, and a pelvic ultrasound was ordered. The ultrasound findings showed a 4 cm cervical mass, the etiology of which was uncertain, as well as endometrial stripe thickening (Figure 1). Magnetic resonance imaging (MRI) of the pelvis was then obtained for further characterization. The MRI showed a large cervical mass, which was felt to be suspicious for malignancy (Figure 2, 3). She then had a consultation with the Gynecologic-Oncology divi- sion who felt that this was most likely a cervical myoma and recommended no further intervention. The patient then returned with further, heavier vaginal bleeding and was taken to the operating room for a dilatation and curettage with hysteroscopy. At surgery, the uterine cavity sounded to a depth of 7 centimeters. Upon hysteroscopically inspecting the cavity, multiple small fundal polyps were noted, as well as what appeared to be a large cervical myoma (Figure 4, 5). The continuous flow resectoscope was used to resect the pathology found (Figure 6). Blood loss and fluid deficit were minimal. The patient had an uneventful initial postoperative course. JSLS (1999)3:145-147 145