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Trivedi S, Gothwal M, Binit S, Singh P. Disseminated peritoneal leiomyoma: a diagnostic dilemma. BMJ Case Rep 2024; 17:e259093. [PMID: 38862186 DOI: 10.1136/bcr-2023-259093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Disseminated peritoneal leiomyomatosis (DPL) is a rare and benign clinical entity. It is also known as leiomyomatosis peritonealis disseminata (LPD). Here, we report and discuss a case of a primiparous woman in her early 40s who presented with heavy, prolonged, painful menses and heaviness in her lower abdomen. She underwent a laparoscopic myomectomy for a fibroid uterus, 12 months ago for similar complaints. On workup, she was diagnosed with DPL. We performed a total abdominal hysterectomy with bilateral salpingectomy, low anterior resection with stapled colorectal anastomosis and excision of peritoneal tumour deposits in consortium with the gastrosurgery team. Her postoperative period was uneventful, and the patient was discharged on postop day 6. Her histopathology report was consistent with leiomyoma; the follow-up period was uneventful.
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Affiliation(s)
- Swati Trivedi
- Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Meenakshi Gothwal
- Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Sureka Binit
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| | - Pratibha Singh
- Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
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2
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Sood A, Gupta RG, Mishra GV, Khandelwal S, Suryadevara M. Wandering Fibroid in a Post Menopausal Woman From Rural India: A Case Report. Cureus 2023; 15:e42734. [PMID: 37654941 PMCID: PMC10467329 DOI: 10.7759/cureus.42734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Fibroids, also known as uterine leiomyomas, are the most common solid benign lesions of the uterus. Fibroids are responsive to hormones and are stimulated by estrogens and commonly grow during pregnancy and involute as menopause progresses. The treatment is mostly conservative. When symptomatic, the treatment requires surgical intervention. We present a case of a 72-year-old post-menopausal female with a large, calcified parasitic fibroid, an extremely rare variant of uterine leiomyoma occurring outside the uterus. The number of cases reported about this pathology is minimal.
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Affiliation(s)
- Anshul Sood
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roohi G Gupta
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shreya Khandelwal
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manasa Suryadevara
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Mercorio A, Della Corte L, Vetrella M, Russo M, Serafino P, Palumbo M, Viciglione F, Cafasso V, Bifulco G, Giampaolino P. Uterine fibroids morcellation: a puzzle topic. MINIM INVASIV THER 2022; 31:1008-1016. [DOI: 10.1080/13645706.2022.2095872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Antonio Mercorio
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Martino Vetrella
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Mario Russo
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Paolo Serafino
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Mario Palumbo
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Francesco Viciglione
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Valeria Cafasso
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
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4
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Barik A, Singh V. A Curious Case of Parasitic Fibroid in a Postmenopausal Woman. Cureus 2022; 14:e25048. [PMID: 35719779 PMCID: PMC9200108 DOI: 10.7759/cureus.25048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/21/2022] Open
Abstract
Parasitic fibroids or leiomyomas are rare extrauterine benign tumors in women of reproductive age. Often, they are named wandering fibroids or ectopic fibroids. They lack any myometrial connection and obtain their nourishment from other abdominopelvic structures to which they are attached. Clinicians often find it difficult to diagnose these fibroids preoperatively due to their atypical presentations and locations. Recent studies have suggested that the development of parasitic fibroids is iatrogenic. Inadvertent seeding of fibroid fragments during the morcellation procedure in a previous laparoscopic myomectomy surgery could be the pathogenesis. However, in rare scenarios, they may develop spontaneously with no history of surgery or a coexistent uterine fibroid. In this report, we present a case of parasitic fibroid in a 75-year-old postmenopausal woman. She had no surgical history, and she had a normal uterus. Radiological investigations had initially suggested the mass to be a subserous fibroid. However, it was diagnosed as parasitic fibroid intraoperatively, confirmed later by histopathological examination.
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5
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Jiang L, Tong D, Li Y, Liu Q, Liu K. Application of Single-Port Laparoscopic Surgery in Myomectomy. Front Oncol 2021; 11:722084. [PMID: 34631550 PMCID: PMC8497760 DOI: 10.3389/fonc.2021.722084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
Research Question The use of a power morcellator in laparoscopic myomectomy is a controversial topic. The application of single-port laparoscopy solves this problem, but its safety, efficacy and prognosis are also challenges. The purpose of this study was to compare the clinical application of single-port laparoscopy and traditional three-port laparoscopy in myomectomy. Design This is a retrospective review of a total of 120 patients who underwent single-port laparoscopic myomectomy (n=60) or traditional three-port laparoscopic myomectomy (n=60), performed between January 2019 to December 2020. The operation time, intraoperative blood loss, specimen removal time, hemoglobin change after operation, postoperative ambulation time, first exhaust time after surgery, the length of hospital stay, pain score on the day, the first day after operation and the satisfaction of abdominal wall scar were evaluated for the surgical outcomes. Results Compared with the traditional three-port laparoscopic group, the specimen removal time, postoperative ambulation time, first exhaust time after surgery, the length of hospital stay were all shorter, the satisfaction of abdominal wall scar were higher in single-port laparoscopic group. The duration of surgery was longer in single-port laparoscopic group significantly. The differences were statistically significant (P<0.05). The intraoperative blood loss, hemoglobin change after operation, pain score on the day of operation and the first day after operation of the two groups had no differences (P>0.05). Conclusions The clinical effect of single-port laparoscopic myomectomy is satisfactory and can be popularized in clinic.
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Affiliation(s)
- Lili Jiang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Deming Tong
- Department of General Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Yan Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qifang Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Kuiran Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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6
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Iatrogenic Port Site Parasitic Myoma; Case Report and Literature Review. Int Surg 2021. [DOI: 10.9738/intsurg-d-15-00104.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction
We report a case of iatrogenic parasitic myoma of the anterior abdominal wall and discuss the differential diagnosis, treatment, and prevention of complication with relevant literature.
Case Report
A 33-year-old woman presented with anterior abdominal wall mass 3 years after initial laparoscopic myomectomy surgery. A mass with a 38 × 26 mm diameter was observed in the anterior abdominal wall at the site of inferior left side port of previous surgery. It was excised from the anterior abdominal wall outside of the peritoneum, below the fascia. The pathologic examination of the excised mass revealed cellular myoma. This case is the 4th port site parasitic myoma in literature.
Conclusion
The risk of implantation and subsequent growth of minute myoma fragments should be kept in mind during morcellation procedures and, in order to avoid such complications, all fragments should be tracked during morcellation. The inspection of trocar sites after the removal of trocars for retained fragments would prevent such recurrences.
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7
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Thang NM, Thien DH, Huyen Anh NT, Cuong TD. Leiomyomatosis peritonealis dissemianata five years after laparoscopic uterine myomectomy: A case report. Ann Med Surg (Lond) 2021; 66:102377. [PMID: 34026111 PMCID: PMC8131390 DOI: 10.1016/j.amsu.2021.102377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Leiomyomatosis peritonealis disseminata (LPD) is a rare disease that can be challenging to diagnose. In this report, we present a case of LPD arising 5 years after laparoscopic uterine myomectomy using a power morcellator. Presentation of case A 32-year-old woman was admitted to our hospital with complaints of vaginal bleeding and abdominal discomfort. Five years previously, she had undergone laparoscopic uterine myomectomy using a power morcellator. Pelvic ultrasonography and magnetic resonance imaging demonstrated multiple pelvic tumors closely attached to peritoneum with no indication of malignancy. An exploratory laparotomy revealed multiple sites of leiomyomatosis in the peritoneum, especially on the parietal peritoneum at the port site of the previous laparoscopic surgery. We surgically removed all visible tumors and performed a total hysterectomy. Histologic examination confirmed the diagnosis of LPD. Discussion The use of a power morcellator without in-bag containment system might have played a role in the pathogenesis of LPD in our case. Ultrasonography, computed tomography, and MRI are among the most effective to distinguish between leiomyomas and other solid tumors in the pelvis, but they are not of great help in the differential diagnosis of malignancies. Conclusion The physicians need to combine medical history, clinical findings, imaging techniques and histopathological examination to establish a correct diagnosis of LPD. The application of containment bags in the setting of power morcellation should be considered to reduce the risk of developing LPD. The optimal intervention strategy should be chosen according to the particular features of each patient. Leiomyomatosis peritonealis disseminata (LPD) is a rare disease that can be challenging to diagnose. The physician should suspect LPD when the woman has a history of hysterectomy or myomectomy, particularly if a power morcellator was used. Ultrasonography, computed tomography, and MRI are among the most effective to distinguish between leiomyomas and other solid tumors in the pelvis, but they are not of great help in the differential diagnosis of malignancies. Tumor markers such as CEA, CA19-9 and CA-125 seem not to be useful for the differential diagnosis, since LPD are sometimes associated with elevated levels of these markers.
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Affiliation(s)
- Nguyen Manh Thang
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Viet Nam.,National Hospital of Obstetrics and Gynecology, Hanoi, Viet Nam
| | - Dang Hong Thien
- National Hospital of Obstetrics and Gynecology, Hanoi, Viet Nam
| | - Nguyen Thi Huyen Anh
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Viet Nam
| | - Tran Danh Cuong
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Viet Nam.,National Hospital of Obstetrics and Gynecology, Hanoi, Viet Nam
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8
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Pepin K, Cope A, Einarsson JI, Cellini J, Cohen SL. Safety of Minimally Invasive Tissue Extraction in Myoma Management: A Systematic Review. J Minim Invasive Gynecol 2020; 28:619-643. [PMID: 32977002 DOI: 10.1016/j.jmig.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This review seeks to establish the incidence of adverse outcomes associated with minimally invasive tissue extraction at the time of surgical procedures for myomas. DATA SOURCES Articles published in the following databases without date restrictions: PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews and Trials. Search was conducted on March 25, 2020. METHODS OF STUDY SELECTION Included studies evaluated minimally invasive surgical procedures for uterine myomas involving morcellation. This review did not consider studies of nonuterine tissue morcellation, studies involving uterine procedures other than hysterectomy or myomectomy, studies involving morcellation of known malignancies, nor studies concerning hysteroscopic myomectomy. A total of 695 studies were reviewed, with 185 studies included for analysis. TABULATION, INTEGRATION, AND RESULTS The following variables were extracted: patient demographics, study type, morcellation technique, and adverse outcome category. Adverse outcomes included prolonged operative time, morcellation time, blood loss, direct injury from a morcellator, dissemination of tissue (benign or malignant), and disruption of the pathologic specimen. CONCLUSION Complications related to morcellation are rare; however, there is a great need for higher quality studies to evaluate associated adverse outcomes.
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Affiliation(s)
- Kristen Pepin
- Department of Obstetrics & Gynecology, Weill Cornell Medical Center, New York, New York (Dr. Pepin).
| | - Adela Cope
- Department of Obstetrics & Gynecology, The Mayo Clinic, Rochester, Minnesota (Drs. Cope and Cohen)
| | - Jon I Einarsson
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital (Dr. Einarsson)
| | - Jacqueline Cellini
- Department of Research & Instruction, Harvard TH Chan School of Public Health (Ms. Cellini), Boston, Massachusetts
| | - Sarah L Cohen
- Department of Obstetrics & Gynecology, The Mayo Clinic, Rochester, Minnesota (Drs. Cope and Cohen)
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9
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Darii N, Anton E, Doroftei B, Ciobica A, Maftei R, Anton SC, Mostafa T. Iatrogenic parasitic myoma and iatrogenic adenomyoma after laparoscopic morcellation: A mini-review. J Adv Res 2019; 20:1-8. [PMID: 31080671 PMCID: PMC6505034 DOI: 10.1016/j.jare.2019.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 02/05/2023] Open
Abstract
Laparoscopy is widely recognized as a procedure of choice for gynaecological surgery. Myomectomy and hysterectomy are the most frequently performed surgical procedures in gynaecology. A morcellator is often used in myomectomies or subtotal hysterectomies, but morcellation may cause rare complications, such as parasitic iatrogenic myoma or adenomyoma. To improve patient counselling, proper risk estimation as well as risk factor identification should be acknowledged. This article aimed to review the literature on parasitic myoma and adenomyoma and to compare these diseases in terms of clinical, surgical, and prognostic factors. All published literature (case series and case reports) on iatrogenic myoma and adenomyoma was reviewed using PubMed/MEDLINE and ScienceDirect resources. Despite both conditions having an iatrogenic origin, iatrogenic parasitic myoma and adenomyoma are two different entities in terms of clinical manifestations as well as intraoperative particularities, with a common point: iatrogenic complication. A possible solution to avoid these iatrogenic complications is by using in-bag morcellation or switching to another surgical procedure (e.g., a vaginal or abdominal approach). It is concluded that parasitic myoma and iatrogenic adenomyoma are two different iatrogenic morcellator-related complications. In patients with a history of uterus or myoma morcellation who report pelvic symptoms, iatrogenic parasitic myoma or adenomyoma should be considered in the differential diagnosis.
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Affiliation(s)
- Natalia Darii
- Department of Gynecology, Cuza Voda Hospital, University of Medicine and Pharmacology Gr T Popa, 700038 Iasi, Romania
| | - Emil Anton
- Department of Gynecology, Cuza Voda Hospital, University of Medicine and Pharmacology Gr T Popa, 700038 Iasi, Romania
| | - Bogdan Doroftei
- Department of Gynecology, Cuza Voda Hospital, University of Medicine and Pharmacology Gr T Popa, 700038 Iasi, Romania
| | - Alin Ciobica
- Department of Research, Faculty of Biology, Alexandru Ioan Cuza University, B dul Carol I, 700506, no 11, Iasi, Romania
| | - Radu Maftei
- Department of Gynecology, Cuza Voda Hospital, University of Medicine and Pharmacology Gr T Popa, 700038 Iasi, Romania
| | - Sorana C. Anton
- “Grigore T.Popa” University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
| | - Taymour Mostafa
- Department of Andrology and Reproduction, Faculty of Medicine, Cairo University, Al-Saray Street, El Manial Cairo 11956, Egypt
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10
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Withers A, Mitchell A, Holsten S. Surgical Management of a Parasitic Leiomyoma within a Ventral Hernia. Am Surg 2019. [DOI: 10.1177/000313481908500904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Shaukat I, Yassin S, Paudel A, Höti N, Mustafa S. Unusual presentation of parasitic leiomyoma; a tale of twists and turns. J Community Hosp Intern Med Perspect 2019; 9:168-170. [PMID: 31044051 PMCID: PMC6484481 DOI: 10.1080/20009666.2019.1591899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 03/01/2019] [Indexed: 01/01/2023] Open
Abstract
Uterine leiomyoma is the most common benign pelvic tumor of the myometrium, as the prevalence could be as high as 70%. Major risk factors include age between 40–60 years and African descent. It usually presents with abnormal uterine bleeding and/or pelvic pain or pressure. Extra-uterine cases of leiomyoma have been reported including Leiomyomatosis Peritonealis Disseminata (LPD), in which multiple nodules are found in the pelvis, peritoneum, or intestine. The term parasitic leiomyoma has been used in literature to describe a non-disseminating pattern . There is no clear explanation for pathogenesis; however, some reports linked it to previous uterine procedures. We are presenting here a case report of an unusual presentation of extra-uterine leiomyoma in a patient with a remote history of hysterectomy for uterine fibroids.
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Affiliation(s)
- Irfan Shaukat
- Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA
| | - Sayf Yassin
- Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Amrit Paudel
- Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA.,Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Naseruddin Höti
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Urology, University of Texas Health Science CenterSan Antonio, San Antonio, TX, USA
| | - Sadaf Mustafa
- Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA.,Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
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12
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Paul PG, Shintre H, Mehta S, Gulati G, Paul G, Mannur S. Parasitic Myomas: An Unusual Risk after Morcellation. Gynecol Minim Invasive Ther 2018; 7:124-126. [PMID: 30254954 PMCID: PMC6135166 DOI: 10.4103/gmit.gmit_36_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 24-year-old unmarried woman had undergone laparoscopic myomectomy for single degenerated myoma of size 15 cm. Uncontained morcellation of the myoma was done with an electromechanical morcellator. Two years later, she presented with abdominal pain, and laparoscopy revealed enlarged uterus (20 weeks) with multiple degenerated myomas. There were multiple parasitic myomas measuring 1-3 cm in the pelvis and anterior abdominal wall which were removed laparoscopically. Histopathology of all the myomas including parasitic myomas confirmed the diagnosis of leiomyoma. The formation of parasitic myomas was assumed to be due to the myomatous fragments which were left behind during morcellation at the time of initial myomectomy. Methods to prevent this complication are colpotomy, mini-laparotomy, or in-bag morcellation.
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Affiliation(s)
- P G Paul
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Kochi, Kerala, India
| | - Hemant Shintre
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Kochi, Kerala, India
| | - Santwan Mehta
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Kochi, Kerala, India
| | - Gunjan Gulati
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Kochi, Kerala, India
| | - George Paul
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Kochi, Kerala, India
| | - Sumina Mannur
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Kochi, Kerala, India
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13
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Kriplani A, Mahey R, Gupta M, Ray M, Bansal V. Complications of Laparoscopic Morcellation: Two Cases and a Review of the Literature. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monica Gupta
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - M.D. Ray
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - V.K. Bansal
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
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14
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Wong M, De Wilde RL, Isaacson K. Reducing the spread of occult uterine sarcoma at the time of minimally invasive gynecologic surgery. Arch Gynecol Obstet 2017; 297:285-293. [PMID: 29128980 DOI: 10.1007/s00404-017-4575-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/19/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE This review covers the most recent evidence to discuss the incidence of occult uterine sarcoma, whether morcellation increases tumor dissemination or mortality, and whether there is a difference between different types of morcellation. We will also discuss techniques to reduce the spread of an undiagnosed uterine sarcoma. METHOD A comprehensive literature search was made in Pubmed, Medline, the Cochrane Library, and Google Scholar for articles related to the incidence of occult uterine sarcoma after morcellation. RESULTS Fibroids are benign uterine tumors and are a common indication for gynecologic surgery. Increasingly, gynecologists are approaching these surgeries with minimally invasive techniques. Uterine sarcomas are rare malignant mesenchymal tumors that are difficult to distinguish preoperatively from uterine fibroids. CONCLUSION During a minimally invasive surgery, there is a risk of disseminating an occult sarcoma during tissue extraction. Minimally invasive gynecologists are tasked with balancing taking a minimally invasive approach, which is shown to result in better patient outcomes, with minimizing the risk of spreading an occult sarcoma.
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Affiliation(s)
- Marron Wong
- Newton-Wellesley Hospital, Center for Minimally Invasive Gynecologic Surgery, Harvard Medical School, Newton, MA, USA
| | - Rudy Leon De Wilde
- Department of Gynecology, Obstetrics and Gynecological Oncology at Pius Hospital, University Hospital for Gynecology-Carl von Ossietzky University, Oldenburg, Germany.
| | - Keith Isaacson
- Newton-Wellesley Hospital, Center for Minimally Invasive Gynecologic Surgery, Harvard Medical School, Newton, MA, USA
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15
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Techniques for Laparoscopic Contained Tissue Extraction. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Huang BS, Yang MH, Wang PH, Li HY, Chou TY, Chen YJ. Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation. Reprod Biol Endocrinol 2016; 14:64. [PMID: 27716434 PMCID: PMC5053344 DOI: 10.1186/s12958-016-0200-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/29/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Iatrogenic parasitic myomas (PMs), caused by intra-corporeal power morcellation during laparoscopy is gradually increasing. However, the pathogenesis and medical treatment of PMs remain largely unelucidated. METHODS Laparoscopically-induced PM xenografted mouse model was conducted by xenografting human uterine myoma fragments into the abdominal cavity of SCID mice and hormonal manipulation was performed using this mouse model to demonstrate the role of oestrogen in the development of implanted PMs. Immunohistochemistry of oestrogen receptor α (ERα), progesterone receptor (PR), vimentin, vascular endothelial growth factor (VEGF), microvessel density (MVD) and Ki-67 index was performed and compared. RESULTS In the patient with PMs, ERα, PR, angiogenesis and proliferative property expression were upregulated in PM lesions compared to uterine myomas. In the laparoscopically-induced PM mouse model, implanted myomas had more steroid receptor expressions, angiogenesis and proliferative property compared with pre-xenografted or non-implanted myoma. Depletion of oestrogen in the ovariectomized (OVX) mice decreased laparoscopically-induced PM implantations. In comparison, the implantations of PMs were increased with additional E2 supplement. Hormonal manipulation in the PM mouse model, including AI, GnRHa and SERM groups, were compared and AI significantly decreased the implantations, steroid receptor, angiogenesis, cell density, and proliferative index of PMs compared with control group. Furthermore, GnRHa significantly decreased VEGF and MVD expressions compared with control group. CONCLUSIONS These data highlight the crucial role of oestrogen in the development of laparoscopically-induced PMs and suggest that hormone manipulation may be a potential therapeutic agent. TRIAL REGISTRATION This protocol was approved by the Human and Animal Institutional Review Board of Taipei Veterans General Hospital ( VGHIRB No 2014-10-002C on Nov. 17th, 2014; IACUC 2014-119 on Aug. 22nd, 2014).
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Affiliation(s)
- Ben-Shian Huang
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, National Yang-Ming University Hospital, No.169, Siaoshe Road, Yilan, 260 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Muh-Hwa Yang
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Hsin-Yang Li
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
| | - Teh-Ying Chou
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
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Sekulic M, Moench L, Movahedi-Lankarani S. Disseminated peritoneal leiomyomatosis postmorcellated resection of uterine leiomyomatous tissue. APMIS 2016; 124:1063-1071. [DOI: 10.1111/apm.12601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/03/2016] [Indexed: 01/30/2023]
Affiliation(s)
- Miroslav Sekulic
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis MN USA
| | - Laura Moench
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis MN USA
| | - Saeid Movahedi-Lankarani
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis MN USA
- Department of Pathology; Abbott Northwestern Hospital; Minneapolis MN USA
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Liu H, Zhu Y, Zhang GN, Wang C, Li C, Shi Y. Laparoscopic surgery on broken points for uterine sarcoma in the early stage decrease prognosis. Sci Rep 2016; 6:31229. [PMID: 27503773 PMCID: PMC4977497 DOI: 10.1038/srep31229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/14/2016] [Indexed: 12/14/2022] Open
Abstract
Uterine sarcoma, a rare solid tumor in uterus, is difficult to identify in the early stage from some benign uterine tumors, such as uterine fibroids. Hence, uterine sarcoma may be treated in the same way as uterine fibroids; and this may not be found until pathological diagnosis. Consequently, this can lead to tumor's abdominal spread, planting and local invasive growth, resulting in an early uterine sarcoma, an increased relapse rate after surgery and a decreased survival. Therefore, it's important to avoid these unintended and iatrogenic complications through an accurate diagnosis and an appropriate surgical approach. The surgical staging and a complete resection of the tumor are both important for patients' prognosis. In this review, we will discuss the laparoscopic surgery for uterine sarcoma in the early stage and patients' prognosis.
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Affiliation(s)
- Hong Liu
- Department of Gynecologic Oncology, Sichuan Cancer Hospital, Chengdu, Sichuan, PR China
| | - Yi Zhu
- Department of Gynecologic Oncology, Sichuan Cancer Hospital, Chengdu, Sichuan, PR China
- Department of Ultrasound, Sichuan Cancer Hospital, Chengdu, Sichuan, PR China
| | - Guo-Nan Zhang
- Department of Gynecologic Oncology, Sichuan Cancer Hospital, Chengdu, Sichuan, PR China
| | - Chang Wang
- Department of Obstetrics and Gynecology, Chengdu First People’s Hospital, Chengdu, Sichuan, PR China
| | - Chao Li
- Department of Obstetrics and Gynecology, Chengdu Second People’s Hospital, Chengdu, Sichuan, PR China
| | - Yu Shi
- Department of Gynecologic Oncology, Sichuan Cancer Hospital, Chengdu, Sichuan, PR China
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In-Bag Manual Extraction of Excised Myomas by Surgical Scalpel through Suprapubic Mini-Laparotomic Incision in Laparoscopic-Assisted Myomectomy. J Minim Invasive Gynecol 2016; 23:731-8. [DOI: 10.1016/j.jmig.2016.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 12/28/2022]
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20
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Lete I, González J, Ugarte L, Barbadillo N, Lapuente O, Álvarez-Sala J. Parasitic leiomyomas: a systematic review. Eur J Obstet Gynecol Reprod Biol 2016; 203:250-9. [PMID: 27359081 DOI: 10.1016/j.ejogrb.2016.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/27/2016] [Accepted: 05/13/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Parasitic leiomyomas were first described as early as 1909 but are a rare condition. In recent years, due to the rise of laparoscopic surgery and power morcellation, several cases of parasitic leiomyomas associated with this surgical procedure have been reported. METHODS A literature search was performed using PubMed, Embase and Google Scholar with the following combination of keywords: leiomyoma OR uterine neoplasms OR uterine myomectomy OR laparoscopy OR hysterectomy OR peritoneal neoplasms AND parasitic. Papers describing parasitic leiomyomas were included. The results of these studies are summarized herein. RESULTS We retrieved abstracts of 756 papers. Of these, 591 were excluded for not fulfilling the inclusion criteria and 54 were removed as duplicates; after full-text assessment, 8 were rejected for presenting cases of malignancy and finally 103 were included in our systematic review. From these, we present information about 274 patients with parasitic leiomyomas. The mean age of women was 40 years (range 18-79 years); and 154 (56%) had no history of uterine surgery, the others (120, 44%) having had a previous myomectomy or hysterectomy. Of the total, 106 (39%) women had a history of power morcellation. The most frequent clinical symptom was abdominal pain (49%) and the most frequent presentation was disseminated peritoneal leiomyomatosis. CONCLUSIONS While parasitic leiomyoma was first described a century ago, the recent introduction of laparoscopic power morcellation has increased the number of reported cases.
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Affiliation(s)
- Iñaki Lete
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain; School of Medicine, Basque Country University, Vitoria, Spain; BioAraba Research Unit, Vitoria, Spain.
| | - Janire González
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
| | - Lorea Ugarte
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
| | - Nagore Barbadillo
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
| | - Oihane Lapuente
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
| | - Javier Álvarez-Sala
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
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Nappi L, Sorrentino F, Angioni S, Pontis A, Barone I, Greco P. Leiomyomatosis Peritonealis Disseminata (LPD) ten years after laparoscopic myomectomy associated with ascites and lymph nodes enlargement: a case report. Int J Surg Case Rep 2016; 25:1-3. [PMID: 27280492 PMCID: PMC4972128 DOI: 10.1016/j.ijscr.2016.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/15/2016] [Accepted: 05/17/2016] [Indexed: 12/19/2022] Open
Abstract
Leiomyomatosis peritonealis disseminata (LPD) is a rare pathology of unkown etiology. The relationship of LPD with myoma morcellation remains unclear. Ascites with lymph node enlargement can be present in LPD. Time of clinical presentation of LPD can be very long after laparoscopic myomectomy.
Introduction We report a case of leiomyomatosis peritonealis disseminata (LPD) arising 10 years after a laparoscopic myomectomy that was associated with ascites and lymph nodes enlargement. Presentation of case The patient presented with small uterine fibroids with a dominant posterior intramural fibroid measuring 9 cm in diameter and normal Doppler. Laparotomy revealed a uterus enlarged with fibroids, which was densely adhering to the urinary bladder, greater omentum, and sigmoid colon. Multiple tumors of different size were found attached to the peritoneum, omentum and bowel. The histopathologic examination was consistent with leiomyomatosis peritonealis disseminata. Discussion Pieces of smooth muscle cell lost in the abdominal cavity during electrical morcellation after laparoscopic myomectomy may progress to leiomyomatosis peritonealis disseminata even after many years (ten in our case) and it can be associated with ascites and lymph nodes enlargement. Conclusion This is the first case reported in literature of leiomyomatosis peritonealis disseminata with these particular features (time of clinical presentation, ascites, lymph nodes enlargement).
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Affiliation(s)
- Luigi Nappi
- Institute of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Felice Sorrentino
- Institute of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - Stefano Angioni
- Institute of Obstetrics and Gynaecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Alessandro Pontis
- Institute of Obstetrics and Gynaecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Ida Barone
- Institute of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pantaleo Greco
- Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynaecology, University of Ferrara, Ferrara, Italy
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Tulandi T, Leung A, Jan N. Nonmalignant Sequelae of Unconfined Morcellation at Laparoscopic Hysterectomy or Myomectomy. J Minim Invasive Gynecol 2016; 23:331-7. [DOI: 10.1016/j.jmig.2016.01.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 01/12/2023]
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Paul PG, Rengaraj V, Das T, Garg R, Thomas M, Khurd AS. Uterine Sarcomas in Patients Undergoing Surgery for Presumed Leiomyomas: 10 Years' Experience. J Minim Invasive Gynecol 2015; 23:384-9. [PMID: 26677821 DOI: 10.1016/j.jmig.2015.11.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/23/2015] [Accepted: 11/26/2015] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To find the incidence of sarcomas in patients undergoing surgery for presumed leiomyomas. DESIGN Retrospective study (Canadian Task Force classification II-3). SETTING Paul's Hospital, Centre for Advanced Laparoscopy and Infertility, Kochi, India. PATIENTS All women who underwent total laparoscopic hysterectomy (TLH), laparoscopic myomectomy (LM), and hysteroscopic myomectomy (HM) at Paul's Hospital for presumed leiomyomas from January 1, 2004 to December 31, 2014 that were then diagnosed as sarcomas on histopathologic examination. INTERVENTIONS TLH, LM, and HM. MEASUREMENTS AND MAIN RESULTS A total of 2678 patients underwent TLH, LM, and HM at Paul's Hospital for presumed leiomyomas from January 1, 2004 to December 31, 2014. Five patients were diagnosed as leiomyosarcoma and 3 patients as endometrial stromal sarcoma on histopathologic examination. Women's ages ranged from 12 to 53 years. Histopathologic diagnosis of leiomyosarcoma was made in 3 patients from the TLH group and 2 patients from the myomectomy group. Two patients from the TLH group and 1 patient from the myomectomy group were diagnosed as endometrial stromal sarcoma on histopathologic examination. The incidence of uterine sarcomas (leiomyosarcoma and endometrial stromal sarcoma) in patients undergoing surgery for presumed leiomyomas was found to be .29% (1 in 335 patients) in our study. CONCLUSION Over a period of 10 years (2004-2014), the incidence of uterine sarcomas in patients undergoing surgery for presumed leiomyomas was found to be .29% in our study.
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Affiliation(s)
- P G Paul
- Centre for Advanced Endoscopy and Infertility, Paul's Hospital, Cochin, Kerala, India.
| | - Varsha Rengaraj
- Centre for Advanced Endoscopy and Infertility, Paul's Hospital, Cochin, Kerala, India
| | - Tanuka Das
- Centre for Advanced Endoscopy and Infertility, Paul's Hospital, Cochin, Kerala, India
| | - Reena Garg
- Centre for Advanced Endoscopy and Infertility, Paul's Hospital, Cochin, Kerala, India
| | - Manju Thomas
- Centre for Advanced Endoscopy and Infertility, Paul's Hospital, Cochin, Kerala, India
| | - Aditya S Khurd
- Centre for Advanced Endoscopy and Infertility, Paul's Hospital, Cochin, Kerala, India
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Unexpected Leiomyosarcoma 4 Years after Laparoscopic Removal of the Uterus Using Morcellation. Case Rep Obstet Gynecol 2015; 2015:723606. [PMID: 26491585 PMCID: PMC4602326 DOI: 10.1155/2015/723606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Laparoscopic hysterectomies are increasingly popular; a morcellation device is often used. Although there are some clear benefits, morcellation of tissue does have potential risks. Case Presentation. In this case report we present a 55-year-old woman with an abdominal tumour 4 years after a laparoscopic hysterectomy using a morcellation device. Postoperative histological analysis, compromised by morcellated tissue, showed benign myoma. Because of the benign tumour no follow-up was performed. The patient presented now with an abdominal tumour, and she was scheduled for surgical removal of the tumour. During abdominal surgery the tumour appeared malignant and biopsies were taken. Histological analysis showed leiomyosarcoma, and the patient was referred to a third care centre for further treatment. The patient recovered quickly after abdominal removal of the tumour; however, after 7 months the patient had complaints and a CT scan showed a large intra-abdominal tumour with possible lung metastasis. The patient received palliative chemotherapy and died after 10 months. Conclusion. This case shows that although unexpected after a hysterectomy, a leiomyosarcoma has to be considered in case of a suspect tumour in the lower abdomen.
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25
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Elsayed MA. Primary parasitic myoma in a young virgin. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Paul PG, Thomas M, Das T, Patil S, Garg R. Contained Morcellation for Laparoscopic Myomectomy Within a Specially Designed Bag. J Minim Invasive Gynecol 2015; 23:257-60. [PMID: 26260302 DOI: 10.1016/j.jmig.2015.08.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/01/2015] [Accepted: 08/04/2015] [Indexed: 01/26/2023]
Abstract
A technique of contained morcellation of uterine myomas within a bag specially designed for 2-port morcellation during laparoscopic myomectomy is described. Ten patients underwent in-bag morcellation of myomas with a tissue isolation bag (MorSafe) between November 2014 and January 2015. The MorSafe tissue isolation bag is a retort-shaped bag made of medical-grade flexible plastic material with the wider opening of 134 mm in diameter and the tail end measuring 4 mm in diameter, allowing easy accomodation of specimens up to 12 cm in diameter. This technique involves placing the myomas into the isolation bag within the abdomen, exteriorizing the tail end of the bag, insufflating the bag within the peritoneal cavity, and morcellating the myomas under vision. Demographic and perioperative characteristics were studied. The mean operative time was 117 minutes (range, 75-195 minutes), the mean time for specimen introduction into the bag was 12.5 minutes (range, 7-22 minutes), and the mean time for morcellation and bag removal was 24.8 minutes (range, 10-50 minutes). There were no complications related to the in-bag morcellation technique, and there was no visual evidence of damage to the isolation bag. In-bag morcellation using this new bag is a feasible technique for morcellating uterine myomas in a contained manner and may provide an option to minimize the risks of open power morcellation while preserving the benefits of minimally invasive surgery.
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Affiliation(s)
- P G Paul
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Cochin, Kerala, India.
| | - Manju Thomas
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Cochin, Kerala, India
| | - Tanuka Das
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Cochin, Kerala, India
| | - Saurabh Patil
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Cochin, Kerala, India
| | - Reena Garg
- Centre for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Cochin, Kerala, India
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28
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Van der Meulen JF, Pijnenborg JMA, Boomsma CM, Verberg MFG, Geomini PMAJ, Bongers MY. Parasitic myoma after laparoscopic morcellation: a systematic review of the literature. BJOG 2015; 123:69-75. [DOI: 10.1111/1471-0528.13541] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 12/22/2022]
Affiliation(s)
- JF Van der Meulen
- Department of Obstetrics and Gynaecology; Màxima Medical Centre; Veldhoven the Netherlands
| | - JMA Pijnenborg
- Department of Obstetrics and Gynaecology; Elisabeth-TweeSteden Hospital; Tilburg the Netherlands
| | - CM Boomsma
- Department of Obstetrics and Gynaecology; Bravis hospital, Bergen op Zoom & Roosendaal; the Netherlands
| | - MFG Verberg
- Department of Obstetrics and Gynaecology; Medisch Spectrum Twente; Enschede the Netherlands
| | - PMAJ Geomini
- Department of Obstetrics and Gynaecology; Màxima Medical Centre; Veldhoven the Netherlands
| | - MY Bongers
- Department of Obstetrics and Gynaecology; Màxima Medical Centre; Veldhoven the Netherlands
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Erenel H, Temizkan O, Mathyk BA, Karataş S. Parasitic myoma after laparoscopic surgery: a mini-review. J Turk Ger Gynecol Assoc 2015; 16:181-6. [PMID: 26401114 DOI: 10.5152/jtgga.2015.15242] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 04/29/2015] [Indexed: 12/26/2022] Open
Abstract
The aim of this review is to summarize the cases of parasitic myomas after laparoscopic surgery. A literature search was performed using the PubMed database for the period of January 1997 to December 2014. We used the following keywords: "laparoscopic hysterectomy," "laparoscopic myomectomy," "morcellation," "parasitic fibroids," "parasitic myomas," and "leiomyomatosis." A total of 29 articles meeting the selection criteria were included in our review, describing 53 patients who underwent surgery for parasitic myomas. Parasitic myoma is a rare condition resulting from the small fibroid fragments left after morcellation and can be either asymptomatic or symptomatic. Although it is rare, patients should be informed about the risk of this condition after laparoscopic surgery. It is important for surgeons to look for small fibroid fragments during and after morcellation and make an effort to remove every piece of tissue.
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Affiliation(s)
- Hakan Erenel
- Clinic of Obstetrics and Gynecology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Osman Temizkan
- Clinic of Obstetrics and Gynecology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Begüm Aydoğan Mathyk
- Clinic of Obstetrics and Gynecology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Suat Karataş
- Clinic of Obstetrics and Gynecology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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30
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Bortoletto P, Einerson BD, Miller ES, Milad MP. Cost-Effectiveness Analysis of Morcellation Hysterectomy for Myomas. J Minim Invasive Gynecol 2015; 22:820-6. [DOI: 10.1016/j.jmig.2015.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
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31
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Tirosh D, Tirosh NB, Goldstein D, Sheizaf B. Large Parasitic Myoma Post Laparoscopic Subtotal Hysterectomy with Morcellation: Case Report and Literature Review. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dan Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Neta Benshalom Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - David Goldstein
- Department of Obstetrics and Gynecology, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Boaz Sheizaf
- Department of Obstetrics and Gynecology, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Beckmann MW, Juhasz-Böss I, Denschlag D, Gaß P, Dimpfl T, Harter P, Mallmann P, Renner SP, Rimbach S, Runnebaum I, Untch M, Brucker SY, Wallwiener D. Surgical Methods for the Treatment of Uterine Fibroids - Risk of Uterine Sarcoma and Problems of Morcellation: Position Paper of the DGGG. Geburtshilfe Frauenheilkd 2015; 75:148-164. [PMID: 25797958 DOI: 10.1055/s-0035-1545684] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 02/08/2023] Open
Abstract
The appropriate surgical technique to treat patients with uterine fibroids is still a matter of debate as is the potential risk of incorrect treatment if histological examination detects a uterine sarcoma instead of uterine fibroids. The published epidemiology for uterine sarcoma is set against the incidence of accidental findings during surgery for uterine fibroids. International comments on this topic are discussed and are incorporated into the assessment by the German Society for Gynecology and Obstetrics (DGGG). The ICD-O-3 version of 2003 was used for the anatomical and topographical coding of uterine sarcomas, and the "Operations- und Prozedurenschlüssel" (OPS) 2014, the German standard for process codes and interventions, was used to determine surgical extirpation methods. Categorical qualifiers were defined to analyze the data provided by the Robert Koch Institute (RKI), the German Federal Bureau of Statistics (DESTATIS; Hospital and Causes of Death Statistics), the population-based Cancer Register of Bavaria. A systematic search was done of the MEDLINE database and the Cochrane collaboration, covering the period from 1966 until November 2014. The incidence of uterine sarcoma and uterine fibroids in uterine surgery was compared to the literature and with the different registries. The incidence of uterine sarcoma in 2010, standardized for age, was 1.53 for Bavaria, or 1.30 for every 100 000 women, respectively, averaged for the years 2002-2011, and 1.30 for every 100 000 women in Germany. The mean incidence collated from various surveys was 2.02 for every 100 000 women (0.35-7.02; standard deviation 2.01). The numbers of inpatient surgical procedures such as myoma enucleation, morcellation, hysterectomy or cervical stump removal to treat the indication "uterine myoma" have steadily declined in Germany across all age groups (an absolute decrease of 17 % in 2012 compared to 2007). There has been a shift in the preferred method of surgical access from an abdominal/vaginal approach to endoscopic or endoscopically assisted procedures to treat uterine fibroids, with the use of morcellation increasing by almost 11 000 coded procedures in 2012. Based on international statements (AAGL, ACOG, ESGE, FDA, SGO) on the risk of uterine sarcoma as an coincidental finding during uterine fibroid surgery and the associated risk of a deterioration of prognosis (in the case of morcellation procedures), this overview presents the opinion of the DGGG in the form of four Statements, five Recommendation and four Demands.
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Affiliation(s)
- M W Beckmann
- Universitätsklinikum Erlangen-Nürnberg, Frauenklinik, Erlangen
| | - I Juhasz-Böss
- Universitätsklinikum des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg
| | - D Denschlag
- Hochtaunus-Kliniken Bad Homburg, Frauenklinik, Bad Homburg
| | - P Gaß
- Universitätsklinikum Erlangen-Nürnberg, Frauenklinik, Erlangen
| | - T Dimpfl
- Klinikum Kassel, Frauenheilkunde und Geburtshilfe, Kassel
| | - P Harter
- Kliniken Essen-Mitte, Gynäkologie & Gynäkologische Onkologie, Essen
| | - P Mallmann
- Uniklinik Köln, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Cologne
| | - S P Renner
- Universitätsklinikum Erlangen-Nürnberg, Frauenklinik, Erlangen
| | - S Rimbach
- Landeskrankenhaus Feldkirch, Gynäkologie und Geburtshilfe, Feldkirch
| | - I Runnebaum
- Universitätsklinikum Jena, Klinik für Frauenheilkunde und Geburtshilfe, Jena
| | - M Untch
- HELIOS Klinikum Berlin-Buch, Klinik für Gynäkologie und Geburtshilfe, Berlin
| | - S Y Brucker
- Universitätsklinikum Tübingen, Frauenklinik, Tübingen
| | - D Wallwiener
- Universitätsklinikum Tübingen, Frauenklinik, Tübingen
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Electric Morcellation-related Reoperations After Laparoscopic Myomectomy and Nonmyomectomy Procedures. J Minim Invasive Gynecol 2015; 22:163-76. [DOI: 10.1016/j.jmig.2014.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 08/12/2014] [Accepted: 09/06/2014] [Indexed: 11/20/2022]
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Buckley VA, Nesbitt-Hawes EM, Atkinson P, Won HR, Deans R, Burton A, Lyons SD, Abbott JA. Laparoscopic Myomectomy: Clinical Outcomes and Comparative Evidence. J Minim Invasive Gynecol 2015; 22:11-25. [DOI: 10.1016/j.jmig.2014.08.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 12/22/2022]
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Incidental gynecologic neoplasms in morcellated uterine specimens: a case series with follow-up. Hum Pathol 2014; 45:2311-7. [DOI: 10.1016/j.humpath.2014.07.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/30/2014] [Accepted: 07/09/2014] [Indexed: 11/22/2022]
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Huang PS, Chang WC, Huang SC. Iatrogenic parasitic myoma: A case report and review of the literature. Taiwan J Obstet Gynecol 2014; 53:392-6. [DOI: 10.1016/j.tjog.2013.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 01/12/2023] Open
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Czarkowski K, Chetty N, Berkes E, Hackethal A. Role and Risks of Morcellation Associated with Laparoscopic Management of Myomas. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0084-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Peritoneal Nodules after Laparoscopic Surgery With Uterine Morcellation: Review of a Rare Complication. J Minim Invasive Gynecol 2014; 21:384-8. [DOI: 10.1016/j.jmig.2014.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/30/2013] [Accepted: 01/02/2014] [Indexed: 11/21/2022]
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Zhang C, Havrilesky LJ, Broadwater G, Di Santo N, Ehrisman JA, Lee PS, Berchuck A, Alvarez Secord A, Bean S, Bentley RC, Valea FA. Relationship between minimally invasive hysterectomy, pelvic cytology, and lymph vascular space invasion: a single institution study of 458 patients. Gynecol Oncol 2014; 133:211-5. [PMID: 24582867 DOI: 10.1016/j.ygyno.2014.02.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/17/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study is to determine whether a minimally invasive approach to hysterectomy is associated with an increased rate of lymph vascular space invasion (LVSI) and/or malignant pelvic peritoneal cytology in endometrial cancer. METHODS We performed a single institution analysis of 458 women with endometrial cancer who underwent either total abdominal hysterectomy (TAH) or minimally invasive hysterectomy (MIH) with use of a disposable uterine manipulator. All patients had endometrial cancer diagnosed by endometrial biopsy at a single academic institution between 2002 and 2012. Exclusion criteria were pre-operative D&C and/or hysteroscopy, uterine perforation or morcellation, and conversion to laparotomy. Multivariate logistic regression models to determine if type of hysterectomy predicts either LVSI or presence of abnormal cytology were controlled for grade, stage, depth of invasion, tumor size, cervical and adnexal involvement. RESULTS LVSI was identified in 39/214 (18%) MIH and 44/242 (18%) TAH (p=0.99). Pelvic washings were malignant in 14/203 (7%) MIH and 16/241 (7%) TAH (p=1.0). Washings were atypical or inconclusive in 16/203 (8%) MIH and 6/241 (2.5%) TAH (p=0.014). In multivariate analyses, type of hysterectomy was not a significant predictor of either LVSI (p=0.29) or presence of malignant washings (p=0.66), but was a predictor of atypical or inconclusive washings (p=0.03). CONCLUSION Minimally invasive hysterectomy with use of a uterine manipulator for endometrial cancer is not associated with LVSI or malignant cytology. Algorithms that better determine the etiology and implications of inconclusive or atypical pelvic cytology are needed to inform the possible additional risk associated with a minimally invasive approach to endometrial cancer.
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Affiliation(s)
- Chelsea Zhang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, Durham, NC 27710, USA.
| | - Gloria Broadwater
- Biostatistics, Duke University Medical Center, Durham, NC 27710, USA
| | - Nicola Di Santo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA
| | - Jessie A Ehrisman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA
| | - Paula S Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, Durham, NC 27710, USA
| | - Andrew Berchuck
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, Durham, NC 27710, USA
| | - Angeles Alvarez Secord
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, Durham, NC 27710, USA
| | - Sarah Bean
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Rex C Bentley
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Fidel A Valea
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, Durham, NC 27710, USA
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Rabischong B, Beguinot M, Compan C, Bourdel N, Kaemmerlen AG, Pouly JL, Canis M, Mage G, Botchorishvili R. Complication à long terme du morcellement utérin par voie cœlioscopique : les myomes parasitiques iatrogènes. ACTA ACUST UNITED AC 2013; 42:577-84. [DOI: 10.1016/j.jgyn.2013.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/28/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
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Leiomyomatosis peritonealis disseminata as a possible result of laparoscopic myomectomy—report of four cases. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s10397-013-0806-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Background Power morcellation has become a common technique for the minimally invasive resection of uterine leiomyomas. This technique is associated with dissemination of cellular material throughout the peritoneum. When morcellated uterine tumors are unexpectedly found to be leiomyosarcomas or tumors with atypical features (atypical leiomyoma, smooth muscle tumor of uncertain malignant potential), there may be significant clinical consequences. This study was undertaken to determine the frequency and clinical consequence of intraperitoneal dissemination of these neoplasms. Methodology/Principal Findings From 2005–2010, 1091 instances of uterine morcellation were identified at BWH. Unexpected diagnoses of leiomyoma variants or atypical and malignant smooth muscle tumors occurred in 1.2% of cases using power morcellation for uterine masses clinically presumed to be “fibroids” over this period, including one endometrial stromal sarcoma (ESS), one cellular leiomyoma (CL), six atypical leiomyomas (AL), three smooth muscle tumor of uncertain malignant potential (STUMPs), and one leiomyosarcoma (LMS). The rate of unexpected sarcoma after the laparoscopic morcellation procedure was 0.09%, 9-fold higher than the rate currently quoted to patients during pre-procedure briefing, and this rate may increase over time as diagnostically challenging or under-sampled tumors manifest their biological potential. Furthermore, when examining follow-up laparoscopies, both from in-house and consultation cases, disseminated disease occurred in 64.3% of all tumors (zero of one ESS, one of one CL, zero of one AL, four of four STUMPs, and four of seven LMS). Only disseminated leiomyosarcoma, however, was associated with mortality. Procedures are proposed for pathologic evaluation of morcellation specimens and associated follow-up specimens. Conclusions/Significance While additional study is warranted, these data suggest uterine morcellation carries a risk of disseminating unexpected malignancy with apparent associated increase in mortality much higher than appreciated currently.
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Unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH): an analysis of 1,584 LASH cases. Arch Gynecol Obstet 2012; 287:455-62. [PMID: 23053310 DOI: 10.1007/s00404-012-2559-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this research was to identify the rate of unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH) and describe the therapy regime. METHODS The research is based on a retrospective chart analysis of patients undergoing a simple hysterectomy in the gynecological endoscopy department of a general hospital in Germany. RESULTS 2,577 simple hysterectomies conducted between March 2005 and March 2010 were sub-classified in different types of hysterectomies (vaginal-, abdominal-, total-, abdominal supracervical hysterectomy, LAVH, and LASH). This study focuses on the LASH sub-group of 1,584 patients and does not make any comparisons to other operative approaches. Out of the 1,584 patients, 87.8 % (n = 1,391) received preoperative screening to exclude dysplasia or malignancy based on the policy of the German Association for gynecology and obstetrics (DGGG). The screening includes cytology (Pap-smear) and preoperative ultrasound of the uterus or dilatation and curettage (d&c). Unexpected malignancies were found in 0.25 % (n = 4) of the patients pre-screened according to DGGG protocol. Out of the four malign patients, two had endometrial cancer. Two patients had leiomyosarcoma. CONCLUSION The study shows that there is a small probability of unexpected malignancies even in correctly pre-screened patients for LASH procedures. Yet in the short-term (28-52 months), malign patients remain recurrence free after treatment. LASH is therefore a good procedure for assumed benign disease.
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Affiliation(s)
- Michael Baggish
- The Women's Center, Saint Helena Hospital, Saint Helena, CA
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH (emeritus)
- Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, CA
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New Challenges in Detecting, Grading, and Staging Endometrial Cancer After Uterine Morcellation. J Minim Invasive Gynecol 2012; 19:313-6. [DOI: 10.1016/j.jmig.2011.12.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 12/20/2011] [Accepted: 12/21/2011] [Indexed: 11/18/2022]
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Yanazume S, Tsuji T, Yoshioka T, Yamasaki H, Yoshinaga M, Douchi T. Large parasitic myomas in abdominal subcutaneous adipose tissue along a previous myomectomy scar. J Obstet Gynaecol Res 2012; 38:875-9. [DOI: 10.1111/j.1447-0756.2011.01784.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sesti F, Di Pietro C, Capece A, Piccione E. Multiple ectopic leiomyomas of the abdominal rectus muscles after gasless laparoscopic uterine myomectomy. Arch Gynecol Obstet 2011; 285:883-5. [PMID: 22045278 DOI: 10.1007/s00404-011-2125-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 10/17/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe and analyze the first case of multiple ectopic leiomyomas of the abdominal rectus muscles in a patient who had undergone gasless laparoscopic uterine myomectomy (GLM) 10 years before. METHODS A 41-year-old woman, who had undergone GLM 10 years before, having presented multiple palpable masses of the abdominal wall, underwent minilaparotomic excision of six abdominal masses. RESULTS Six round well-circumscribed masses of the abdominal rectus muscles, measuring, respectively, 3.8 × 1.7, 2.9 × 0.9, 0.8 × 0.5, 0.7 × 0.3, 10 × 0.8 and 0.5 × 0.4 cm, were excised. The major lesion was situated close to the right trocar site of the previous GLM, the other smaller tumors were located in the umbilical area and left abdominal region. On histopathologic examination, the abdominal lumps were categorized as leiomyoma. CONCLUSIONS Ectopic leiomyomatosis is an uncommon complication after GLM, and does not justify follow-up in all asymptomatic cases. However, the gynecologists should bear this unusual condition in mind, and inform the patients that leiomyoma fragments can grow in ectopic sites.
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Parasitic myomas after laparoscopic surgery: an emerging complication in the use of morcellator? Description of four cases. Fertil Steril 2011; 96:e90-6. [DOI: 10.1016/j.fertnstert.2011.05.095] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 05/15/2011] [Accepted: 05/31/2011] [Indexed: 11/20/2022]
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Aust T, Gale P, Cario G, Robertson G. Bowel resection for iatrogenic parasitic fibroids with preoperative investigations suggestive of malignancy. Fertil Steril 2011; 96:e1-3. [DOI: 10.1016/j.fertnstert.2011.04.097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 04/29/2011] [Indexed: 12/01/2022]
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