1
|
Panesar H, Dhaliwal HS. Iatrogenic Parasitic Leiomyomas: A Late and Uncommon Complication After Laparoscopic Morcellation. Cureus 2022; 14:e24718. [PMID: 35676984 PMCID: PMC9166603 DOI: 10.7759/cureus.24718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/05/2022] Open
Abstract
Parasitic leiomyoma (PL) is an extremely rare variant of uterine leiomyomas that occurs outside of the uterus and can often present like intra-abdominal tumors. The aim of this study is to report a case of PL and compare it with current literature. We present a rare case of a 45-year-old female who presented with bloating and spasmodic abdominal cramps for a two-month duration. She had a previous laparoscopic myomectomy six years ago. Transvaginal ultrasound (TVUS) showed solid vascular masses in the pelvis, the largest being 6 cm. Computed tomography (CT) of the thorax, abdomen, and pelvis (CTTAP) revealed further peritoneal masses in the left paracolic gutter suggesting peritoneal distant metastasis. Laparoscopy was completed, and biopsy and histopathological examination confirmed the diagnosis of parasitic leiomyoma. The patient opted for a bilateral salpingo-oophorectomy (BSO) creating iatrogenic menopause. One-year follow-up CT showed a reduction in the size of fibroids. PL can present with vague symptoms, typically nonspecific abdominal pain and cramping. It can often be confused with intra-abdominal tumors. It should be suspected in patients with previous uterine procedures. Histopathological examination is crucial for diagnostic and surgical management.
Collapse
Affiliation(s)
- Harrypal Panesar
- Otolaryngology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR
| | - Harjit S Dhaliwal
- Department of Obstetrics and Gynaecology, Royal Bournemouth Hospital, Bournemouth, GBR
| |
Collapse
|
2
|
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.
Collapse
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)
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Yoo Jung L, Lee YH, Chung DH, Shin JW. A case of acute abdominal pain caused by infarcted parasitic leiomyoma. J OBSTET GYNAECOL 2019; 40:143-144. [PMID: 31303087 DOI: 10.1080/01443615.2019.1590805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Lee Yoo Jung
- Department of Obstetrics and Gynecology, Gil Medical Center, College of Medicine, Gachon University, Incheon, South Korea
| | - Yae Heun Lee
- Department of Obstetrics and Gynecology, Gil Medical Center, College of Medicine, Gachon University, Incheon, South Korea
| | - Dong Hae Chung
- Department of Pathology, Gil Medical Center, College of Medicine, Gachon University, Incheon, South Korea
| | - Jin Woo Shin
- Department of Obstetrics and Gynecology, Gil Medical Center, College of Medicine, Gachon University, Incheon, South Korea
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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]
|
7
|
Sinha R, Sundaram M, Lakhotia S, Kadam P, Rao G, Mahajan C. Parasitic myoma after morcellation. JOURNAL OF GYNECOLOGICAL ENDOSCOPY AND SURGERY 2012; 1:113-5. [PMID: 22442523 PMCID: PMC3304268 DOI: 10.4103/0974-1216.71612] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We report an interesting case of parasitic fibroid which developed from a morcellation remnant following laparoscopic myomectomy. The patient presented with incidental finding of pelvic mass in 2005. She underwent laparoscopic myomectomy for a myoma extending from the Pouch of Douglas to both sides of broad ligament. She subsequently presented with abdominal pain 3 years later in 2008. She underwent total laparoscopic hysterectomy with removal of broad ligament fibroids. During her hysterectomy, a right lumbar mass attached to the omentum was detected, which was excised laparoscopically. Histopathology of the mass confirmed it to be consistent with leiomyoma. This mass could probably be a morcellation remnant that has grown to this size taking blood supply from the omentum. We report this case to emphasize that all tissue pieces that are morcellated should be diligently removed. Even small bits displaced into the upper abdomen can result in parasitic fibroids. Thus, it can be concluded that parasitic myomas can arise from morcellated remnants and grow depending on the blood supply.
Collapse
Affiliation(s)
- Rakesh Sinha
- Bombay Endoscopy Academy and Centre for Minimally Invasive Surgery (Beams Hospital), Mumbai, India
| | | | | | | | | | | |
Collapse
|
8
|
Makris A, Talmor A, Moyle P, Majmudar T, Abdel-Rahman H. Parasitic fibroid and pseudo–Meigs’ syndrome: Co-existence of two rare entities. J OBSTET GYNAECOL 2012; 32:408-9. [DOI: 10.3109/01443615.2012.657272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
9
|
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]
|
10
|
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]
|
11
|
Nezhat C, Kho K. Iatrogenic Myomas: New Class of Myomas? J Minim Invasive Gynecol 2010; 17:544-50. [PMID: 20580324 DOI: 10.1016/j.jmig.2010.04.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 04/02/2010] [Accepted: 04/23/2010] [Indexed: 12/26/2022]
|
12
|
Payyapilly PG(P, Naik S, Borisa R, Pillai B. Laparoscopic Removal of Multiple Parasitic Myomas Adherent to the Bowel. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2009.0008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Sejal Naik
- Department of Gynecologic Endoscopy, Paul's Hospital, Cochin, India
| | - Renuka Borisa
- Department of Gynecologic Endoscopy, Paul's Hospital, Cochin, India
| | - Biju Pillai
- Department of Gynecologic Endoscopy, Paul's Hospital, Cochin, India
| |
Collapse
|
13
|
Retained uterine fundus after vaginal hysterectomy. J Minim Invasive Gynecol 2010; 17:94-6. [PMID: 20129338 DOI: 10.1016/j.jmig.2009.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 08/29/2009] [Accepted: 09/03/2009] [Indexed: 11/22/2022]
Abstract
We report a case of retained uterine fundus after vaginal hysterectomy that was subsequently removed at laparoscopy. The patient had undergone vaginal hysterectomy 8 years previously and came to our hospital with abdominal pain. Examination revealed a supravesical mass. Laparoscopy was performed and showed the uterine fundus with its cornual attachments. The mass was excised and sent for histopathologic analysis, which confirmed that it was uterine tissue. Retained uterine tissue or myoma tissue has been reported, usually after morcellation. However, to our knowledge, our case is only the second reported case of retained fundus after complete vaginal hysterectomy. Because of adhesions, it is possible that the uterus was not completely removed. In such cases, laparoscopic assistance is extremely useful.
Collapse
|
14
|
Recurrent leiomyomatosis. J Minim Invasive Gynecol 2009; 16:667-8. [PMID: 19896592 DOI: 10.1016/j.jmig.2009.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 01/31/2009] [Accepted: 02/05/2009] [Indexed: 11/23/2022]
|
15
|
|
16
|
Moon HS, Koo JS, Park SH, Park GS, Choi JG, Kim SG. Parasitic leiomyoma in the abdominal wall after laparoscopic myomectomy. Fertil Steril 2008; 90:1201.e1-2. [DOI: 10.1016/j.fertnstert.2007.08.068] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 08/31/2007] [Accepted: 08/31/2007] [Indexed: 01/12/2023]
|