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Parasitic Pelvic and Infradiaphragmatic Leiomyomatosis Following Laparoscopic Myomectomy

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Abstract

Purpose: Uterine leiomyomas are the most common indication for gynecological surgery. The use of power morcellators has facilitated myomectomy, but appears to be associated with leiomyoma seeding, leading to parasitic leiomyomatosis. This is a case report of a patient with parasitic leiomyomatosis following laparoscopic myomectomy, which was detected incidentally during elective gallbladder surgery.

Case Report: A 42-year-old female was treated for symptomatic cholelithiasis in July 2018 by elective laparoscopic cholecystectomy. Three years earlier, the patient had undergone laparoscopic myomectomy using a power morcellator for the removal of a subserosal uterine fibroid 21 cm in diameter. During laparoscopy, a firm nodule, roughly 2 cm in diameter was observed on the right infradiaphragmatic surface, and two smaller, similar pelvic nodules. The infradiaphragmatic nodule was excised and histopathological examination identified it as leiomyoma tissue, confirming the case as parasitic leiomyomatosis.

Discussion: Parasitic leiomyomatosis is a rare entity first described in 1909. Reports of its incidence have increased since the advent of laparoscopic surgery for the treatment of uterine fibroids and there appears to be an association with the use of power morcellators for fragmentation of large myomas, which may promote seeding. Parasitic myoma cells display increased expression of estrogen and progesterone receptors, and increased angiogenetic capacities compared with their uterine counterparts. Further studies are required to ascertain whether power morcellators play a key role in myoma dissemination, and to evaluate possible therapeutic solutions.

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References

  1. 1.

    Sparic R, Mirkovic L, Malvasi A, et al. Epidemiology of Uterine Myomas: A Review. Int J Fertil Steril 2015;9:424-35.

  2. 2.

    Evans P, Brunsell S. Uterine fibroid tumors: Diagnosis and treatment. Am Fam Physician 2007;75:1503-8.

  3. 3.

    Munro MG, Critchley HO, Fraser IS. FIGO Menstrual Disorders Working Group. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril 2011;95:2204-8.

  4. 4.

    Grover A, Bhalla S. Parasitic leiomyoma: a rare complication following laparoscopic myomectomy with review of literature. Curr Med Res Pract 2015;5:278-81.

  5. 5.

    Kelly HA, Cullen TS. Myomata of the uterus. Philadelphia. PA: WB Saunders;1909.

  6. 6.

    Lete I, Gonzalez J, Ugarte L, et al. Parasitic leiomyomas: a systematic review. Eur J Obstet Gynecol Reprod Biol 2016;203:250-9.

  7. 7.

    Kim JH, Baek JH. A Challenging Case of intracardiac leiomyomatosis accompanied by pseudo-meigs syndrome originating from uterine leiomyoma. Ann Vasc Surg 2018;pii: 2019 Feb;55:309.e5-309.e8.

  8. 8.

    Peña A, Tamaña M. Intracardiac extension of intravenous leiomyoma, a rare phenomenon: A case report Radiol Case Report 2018;13:427-30.

  9. 9.

    Huang BS, Yang MH, Wang PH, et al. Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation. Reprod Biol Endocrinol 2016;14:64.

  10. 10.

    Lu B, Xu J, Pan Z. Iatrogenic parasitic leiomyoma and leiomyomatosis peritonealis disseminata following uterine morcellation. J Obstet Gynaecol Res 2016;42:990-9.

  11. 11.

    Ricci S, Stone RL, Fader AN. Uterine leiomyosarcoma: Epidemiology, contemporary treatment strategies and the impact of uterine morcellation. Gynecol Oncol 2017; 145:208-16.

  12. 12.

    Nguyen D, Maheshwary R, Tran C, et al. Diffuse peritoneal leiomyomatosis status post laparoscopic hysterectomy with power morcellation: A case report with review of literature. Gynecol Oncol Rep 2017;19:59-61.

  13. 13.

    Wright JD, Tergas AI, Burke WM, et al. Uterine pathology in women undergoing minimally invasive hysterectomy using morcellation. JAMA 2014;312:1253-5.

  14. 14.

    Updated laparoscopic uterine power morcellation in hysterectomy and myomectomy: FDA safety communication [Internet]. 2014; Available from: https://www.fda.gov/medicaldevices/surgery-devices/laparoscopic-power-morcellators.

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Correspondence to Emmanouil Bakalinis.

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The authors declare that they have no conflict of interest.

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Bakalinis, E., Nikova, A., Gkouma, D. et al. Parasitic Pelvic and Infradiaphragmatic Leiomyomatosis Following Laparoscopic Myomectomy. Hellenic J Surg 91, 133–135 (2019). https://doi.org/10.1007/s13126-019-0521-3

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Key words

  • Parasitic leiomyomatosis
  • leiomyoma
  • laparoscopy
  • power morcellators