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Fujiwara K, Takagi C, Sato M, Tokuda T, Tomita M, Sugita A, Furuya K, Jinushi M, Mitsuya T, Ando N. A parasitic leiomyoma of the sigmoid mesentery with schwannoma-like image findings. Surg Case Rep 2024; 10:212. [PMID: 39254765 PMCID: PMC11387283 DOI: 10.1186/s40792-024-02015-4] [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: 03/14/2024] [Accepted: 09/02/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Parasitic leiomyoma (PL) consists of uterine fibroids separate from the uterus that grow in extrauterine tissues such as the peritoneum and mesenterium. The diagnosis of PL requires a thorough medical history of laparoscopic myomectomies using a morcellator and the identification of typical magnetic resonance imaging (MRI) findings as uterine fibroids. Imaging diagnosis of PL is occasionally difficult when PL degenerates in various ways, owing to atypical findings on computed tomography (CT) and MRI. CASE PRESENTATION A 29-year-old woman with a history of laparoscopic myomectomy visited a local hospital with lower abdominal pain. A mesenteric tumor on the sigmoid mesentery was suspected on MRI, and she was referred to our hospital. CT scan showed strong early contrast uptake in the center of the tumor, and MRI T2-weighted images showed high signals at the tumor margins and low signals in the center, suggesting a schwannoma. PL was also part of the differential diagnosis because of the patient's history of laparoscopic myomectomy. With a preoperative diagnosis of a sigmoid colon mesenteric tumor undeniably of malignant origin, laparoscopic resection of the sigmoid mesenteric tumor was performed. Histopathological examination revealed it to be a PL. CONCLUSIONS We report a case of PL of the sigmoid mesentery with schwannoma-like findings on imaging that was treated laparoscopically. PL is sometimes difficult to distinguish from schwannomas because of the variety of imaging findings, such as uterine fibroids. PL should be considered in the differential diagnosis of mesenteric tumors following laparoscopic myomectomies, even if it does not show typical imaging findings, such as uterine fibroids.
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Affiliation(s)
- Koki Fujiwara
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama, Kanagawa, 245-0006, Japan
| | - Chisato Takagi
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama, Kanagawa, 245-0006, Japan.
| | - Michio Sato
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama, Kanagawa, 245-0006, Japan
| | - Toshiki Tokuda
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama, Kanagawa, 245-0006, Japan
| | - Masato Tomita
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama, Kanagawa, 245-0006, Japan
| | - Atsunori Sugita
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama, Kanagawa, 245-0006, Japan
| | - Kohei Furuya
- Department of Radiology, Keio University Hospital, 35, Shinanomachi, Shinjuku-Ku, Tokyo, 160-0016, Japan
| | - Makoto Jinushi
- Department of Obstetrics and Gynecology, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama, Kanagawa, 245-0006, Japan
| | - Toshiyuki Mitsuya
- Department of Pathology, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama, Kanagawa, 245-0006, Japan
| | - Nobutoshi Ando
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama, Kanagawa, 245-0006, Japan
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2
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Fujita M, Mitsui T, Kunieda S, Fukui M, Kakudo N. Iatrogenic Parasitic Leiomyoma in the Lower Right Abdomen: A Rare Case in Plastic Surgery. Cureus 2024; 16:e65924. [PMID: 39221350 PMCID: PMC11364998 DOI: 10.7759/cureus.65924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
A parasitic leiomyoma has no connection with the uterus itself and obtains its blood supply from the surrounding tissues. A parasitic leiomyoma that develops iatrogenically is called an iatrogenic parasitic leiomyoma. Clinical reports on parasitic leiomyoma are common in gynecology but not in plastic surgery. We report a rare case of an iatrogenic parasitic leiomyoma in a 46-year-old woman who was referred to our plastic surgery department. She presented with the main complaint of a subcutaneous mass in the lower right abdomen and had a history of laparoscopic myomectomy eight years ago. Magnetic resonance imaging showed two masses in the subcutaneous tissue of the lower right abdomen and the posterior rectus abdominis. The excision of these masses was performed through an abdominal wall incision. Histopathological examination revealed that the extracted mass was a leiomyoma. Plastic surgeons must keep in mind the appropriate management of rare cases of parasitic leiomyoma.
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Affiliation(s)
- Maako Fujita
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, JPN
| | - Toshihito Mitsui
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, JPN
| | - Sakurako Kunieda
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, JPN
| | - Michika Fukui
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, JPN
| | - Natsuko Kakudo
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, JPN
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Ota K, Asai S, Takagi S, Kikuchi M, Miyazaki K, Saiki N, Tajima H, Nagase M, Asada H, Ota Y, Takahashi T. Diagnosis and resolution of an enigmatic calcified pelvic mass post-hysterectomy: A case report. Int J Gynaecol Obstet 2024; 165:1297-1299. [PMID: 38358257 DOI: 10.1002/ijgo.15426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/07/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
SynopsisA 73‐year‐old woman with a history of hysterectomy presented with pelvic calcified lesions. Imaging led to laparoscopic surgery, revealing a calcified fibroid after subtotal hysterectomy.
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Affiliation(s)
- Kuniaki Ota
- Department of Obstetrics and Gynecology, Tokyo Rosai Hospital, Tokyo, Japan
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Satoshi Asai
- Department of Obstetrics and Gynecology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Shun Takagi
- Department of Obstetrics and Gynecology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Mahomi Kikuchi
- Department of Obstetrics and Gynecology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Kotaro Miyazaki
- Department of Obstetrics and Gynecology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Naohiko Saiki
- Department of Obstetrics and Gynecology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Hiroto Tajima
- Department of Obstetrics and Gynecology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | | | - Hironori Asada
- Department of Obstetrics and Gynecology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Yoshiaki Ota
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
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4
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Huang Z, Wang Y, Lei H. Parasitic leiomyoma of the greater omentum: a case report and literature review. J Surg Case Rep 2024; 2024:rjad733. [PMID: 38304311 PMCID: PMC10832595 DOI: 10.1093/jscr/rjad733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/03/2024] Open
Abstract
Parasitic leiomyomas (PL), also known as free leiomyomas, which occur outside the uterus and rarely happen in clinical practice. They are usually reported in women of reproductive age who underwent hysterectomy or myomectomy and frequently present with symptoms such as abdominal pain and distention. In fact, it is hard to determine the nature of the mass according to the imaging examination and clinical manifestation. At present, the most common treatment involves an abdominal or laparoscopic surgery in order to remove the mass and perform the next step of treatment based on the histological diagnosis. In this case report, we describe a 35-year-old woman with a 12.4 × 9.3 × 9.8 cm3 PL with blood supply from the greater omentum. Considering the prolonged menstruation of the patient, she underwent the hysteroscopic and laparotomy exploration. The mass was confirmed as smooth leiomyoma with necrosis by the immunohistochemical examination. The patient had a good recovery and being discharged seven days after the surgery. The patient is still in the follow-up.
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Affiliation(s)
- Zhiman Huang
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Yongzhou Wang
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Hongyan Lei
- Department of Gynecology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
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5
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Obrzut B, Kijowska M, Obrzut M, Mrozek A, Darmochwał-Kolarz D. Contained Power Morcellation in Laparoscopic Uterine Myoma Surgeries: A Brief Review. Healthcare (Basel) 2023; 11:2481. [PMID: 37761678 PMCID: PMC10531049 DOI: 10.3390/healthcare11182481] [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: 08/13/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Uterine fibromas are the most common benign uterine tumors. Although the majority of leiomyomas remain asymptomatic, they can cause serious clinical problems, including abnormal uterine bleeding, pelvic pain, and infertility, which require effective gynecological intervention. Depending on the symptoms as well as patients' preferences, various treatment options are available, such as medical therapy, non-invasive procedures, and surgical methods. Regardless of the extent of the surgery, the preferred option is the laparoscopic approach. To reduce the risk of spreading occult malignancy and myometrial cells associated with fragmentation of the specimen before its removal from the peritoneal cavity, special systems for laparoscopic contained morcellation have been developed. The aim of this review is to present the state-of-the-art contained morcellation. Different types of available retrieval bags are demonstrated. The advantages and difficulties associated with contained morcellation are described. The impact of retrieval bag usage on the course of surgery, as well as the effects of the learning curve, are discussed. The role of contained morcellation in the overall strategy to optimize patient safety is highlighted.
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Affiliation(s)
- Bogdan Obrzut
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Medical College, University of Rzeszów, Rejtana 16 C, 35-959 Rzeszow, Poland
| | - Marta Kijowska
- Department of Obstetrics and Gynecology, Provincial Clinical Hospital No. 2 Rzeszow, Lwowska 60, 35-301 Rzeszow, Poland
| | - Marzanna Obrzut
- Institute of Health Sciences, Medical College, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland
| | - Adam Mrozek
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Medical College, University of Rzeszów, Rejtana 16 C, 35-959 Rzeszow, Poland
| | - Dorota Darmochwał-Kolarz
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Medical College, University of Rzeszów, Rejtana 16 C, 35-959 Rzeszow, Poland
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6
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Wang J, Liu G, Yang Q. Parasitic myoma after transabdominal hysterectomy for fibroids: a case report. BMC Womens Health 2023; 23:310. [PMID: 37328846 PMCID: PMC10273530 DOI: 10.1186/s12905-023-02410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/02/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Parasitic myomas typically occur after a pedunculated subserosal fibroid loses its uterine blood supply and parasitizes other organs or after a surgery involving morcellation techniques. Parasitic myomas that occur after transabdominal surgery are extremely rare and may not be sufficiently documented. Here, we present a case of parasitic myoma in the anterior abdominal wall following a transabdominal hysterectomy for fibroids. CASE PRESENTATION The patient was a 46-year-old Chinese woman who had undergone surgery for uterine myomas at our hospital 1 year prior. The patient later revisited our department with a palpable mass in her abdomen, and imaging revealed a mass in the iliac fossa. The possibility of a broad ligament myoma or solid ovarian tumor was considered before surgery, and laparoscopic exploration was performed under general anesthesia. A tumor measuring approximately 4.5 × 4.0 cm was found in the right anterior abdominal wall, and a parasitic myoma was considered. The tumor was completely resected. Pathological analysis of the surgical specimens suggested leiomyoma. The patient recovered well and was discharged on postoperative day 3. CONCLUSION This case suggests that parasitic myoma should be considered in the differential diagnosis of patients presenting with abdominal or pelvic solid tumors with a history of surgery for uterine leiomyomas, even without a history of laparoscopic surgery using a power morcellator. Thorough inspection and washing of the abdominopelvic cavity at the end of surgery is vital.
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Affiliation(s)
- Jiao Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning Province, 110004, China
| | - Guipeng Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning Province, 110004, China.
| | - Qing Yang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, Liaoning Province, 110004, China.
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7
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Goyal LD, Goyal S, Garg P, Mahajan G. Unusual case of a leiomyoma in the space of Retzius mimicking broad ligament fibroid. BMJ Case Rep 2023; 16:e253050. [PMID: 36858429 PMCID: PMC9980378 DOI: 10.1136/bcr-2022-253050] [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: 03/03/2023] Open
Abstract
This case report will discuss an interesting case of a patient who presented with pain in the lower abdomen of 2-month duration. Clinical examination and imaging findings were suggestive of a broad ligament fibroid. However, intraoperatively, the mass was found to be present in the space of Retzius, which is an extremely rare location for such a pathology. The access to the tumour was very challenging. Successful surgical excision was done with the help of a multidisciplinary team involving a gynaecologist, a urologist and an anaesthetist. Histopathology reported it to be benign leiomyoma. Postoperatively, the patient made an uneventful recovery.
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Affiliation(s)
- Lajya Devi Goyal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences-Bathinda, Bathinda, Punjab, India
| | - Suresh Goyal
- General Surgery, All India Institute of Medical Sciences-Bathinda, Bathinda, Punjab, India
| | - Priyanka Garg
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences-Bathinda, Bathinda, Punjab, India
| | - Garima Mahajan
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences-Bathinda, Bathinda, Punjab, India
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8
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Jeon G, Park SY. Parasitic Leiomyoma with Lymphatic Dilatation in Trocar Port-Site of Abdominal Wall: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:280-285. [PMID: 36818706 PMCID: PMC9935948 DOI: 10.3348/jksr.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/16/2022] [Accepted: 06/01/2022] [Indexed: 02/10/2023]
Abstract
Uterine leiomyoma is the most common benign pelvic tumor in female and being symptomatic is an indication for surgical removal. As laparoscopic surgery has been developed, some cases related to parasitic leiomyomas in the port site have been reported. A 40-year-old female who a history of previous laparoscopic surgery to remove uterine myoma 2 years ago visited in outpatient clinic of general surgery with palpable mass in left lower abdomen. Contrast enhanced abdomen CT and pelvis MRI were done to evaluate the mass. It was diagnosed parasitic leiomyoma in pathologic study after surgical removal and parasitic leiomyoma should be considered when patient visited presenting abdominal mass with the history of laparoscopic myomectomy.
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Affiliation(s)
- Gayoung Jeon
- Department of Radiology, Daegu Fatima Hospital, Daegu, Korea
| | - Seo Young Park
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University, Chilgok Hospital, Daegu, Korea
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9
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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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10
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Kathopoulis N, Kypriotis K, Diakosavvas M, Chatzipapas I, Zacharakis D, Grigoriadis T, Protopapas A. Large myoma receiving multiple collateral primary parasitic blood supply. Clin Case Rep 2022; 10:e05945. [PMID: 35702619 PMCID: PMC9178407 DOI: 10.1002/ccr3.5945] [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] [Received: 02/22/2022] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 12/03/2022] Open
Abstract
We describe a rare case of a pedunculated myoma receiving multiple de-novo developed parasitic collateral blood supply from the adjacent organs. The main feeding vessels arise from the omentum and the bladder.
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Affiliation(s)
- Nikolaos Kathopoulis
- Endoscopic Surgery Unit1st Department of Obstetrics & GynecologyNational and Kapodistrian University of Athens, “Alexandra” HospitalAthensGreece
| | - Konstantinos Kypriotis
- Endoscopic Surgery Unit1st Department of Obstetrics & GynecologyNational and Kapodistrian University of Athens, “Alexandra” HospitalAthensGreece
| | - Michail Diakosavvas
- Endoscopic Surgery Unit1st Department of Obstetrics & GynecologyNational and Kapodistrian University of Athens, “Alexandra” HospitalAthensGreece
| | - Ioannis Chatzipapas
- Endoscopic Surgery Unit1st Department of Obstetrics & GynecologyNational and Kapodistrian University of Athens, “Alexandra” HospitalAthensGreece
| | - Dimitrios Zacharakis
- Endoscopic Surgery Unit1st Department of Obstetrics & GynecologyNational and Kapodistrian University of Athens, “Alexandra” HospitalAthensGreece
| | - Themistoklis Grigoriadis
- Endoscopic Surgery Unit1st Department of Obstetrics & GynecologyNational and Kapodistrian University of Athens, “Alexandra” HospitalAthensGreece
| | - Athanasios Protopapas
- Endoscopic Surgery Unit1st Department of Obstetrics & GynecologyNational and Kapodistrian University of Athens, “Alexandra” HospitalAthensGreece
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11
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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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12
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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.
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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
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13
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Marasioni MD, Tsarna E, Tsochrinis A, Chavez N, Georgopapadakos N. An Intraluminal Parasitic Leiomyoma of the Sigmoid Colon and Potential Pathogenetic Mechanisms. Cureus 2021; 13:e18451. [PMID: 34745776 PMCID: PMC8561668 DOI: 10.7759/cureus.18451] [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: 10/03/2021] [Indexed: 11/05/2022] Open
Abstract
Uterine leiomyomas are the most common benign tumor of the female pelvis. Parasitic leiomyomas are an extremely rare entity of leiomyoma occurrence found at extrauterine sites. They are mostly diagnosed in patients with a history of gynecologic procedures and morcellators use during laparoscopic leiomyoma resection. Here we present an extraordinary case of an intraluminal leiomyoma of the sigmoid colon that was incidentally discovered during total abdominal hysterectomy and bilateral salpingo-oophorectomy, performed due to leiomyomatous uterus in a female patient with no history of previous gynecologic operations. Potential pathogenetic mechanisms that can explain the co-occurrence of leiomyomas in the uterus and the sigmoid colon are also reviewed and include genetic predisposition, the stem cell theory of leiomyomas formation, and lymphatic and vascular spread.
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Affiliation(s)
- Maria Dimitra Marasioni
- Department of Obstetrics and Gynecology, General Hospital of Nikaia "Agios Panteleimon", Piraeus, GRC
| | - Ermioni Tsarna
- Department of Obstetrics and Gynecology, General Hospital of Nikaia "Agios Panteleimon", Piraeus, GRC
| | - Alexios Tsochrinis
- Department of Obstetrics and Gynecology, General Hospital of Nikaia "Agios Panteleimon", Piraeus, GRC
| | - Nestor Chavez
- Department of Obstetrics and Gynecology, General Hospital of Nikaia "Agios Panteleimon", Piraeus, GRC
| | - Nikolaos Georgopapadakos
- Department of Obstetrics and Gynecology, General Hospital of Nikaia "Agios Panteleimon", Piraeus, GRC
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14
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Mahmoud MS. Parasitic Intraperitoneal Leiomyoma causing Right Hydronephrosis and Flank Pain. J Minim Invasive Gynecol 2021; 29:11-13. [PMID: 34547459 DOI: 10.1016/j.jmig.2021.09.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Mohamad S Mahmoud
- Minimally Invasive and Robotic Gynecology, Rochester Regional Health, The Women's Center at Rochester General Hospital (Dr. Mahmoud), Rochester, New York.
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15
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Laibangyang A, Law C, Gupta G, Da Dong X, Chuang L. Parasitic leiomyoma causing small bowel perforation: A case report. Case Rep Womens Health 2021; 32:e00349. [PMID: 34430223 PMCID: PMC8365333 DOI: 10.1016/j.crwh.2021.e00349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/04/2022] Open
Abstract
Background Parasitic leiomyomas are rare extra-uterine tumors that can be seen in patients after myomectomy or morcellation of leiomyomas. Case A 63-year-old woman with a history of abdominal myomectomy 20 years prior presented with worsening abdominal distension and pain for the past eight months. The patient delayed care due to fear of the COVID-19 pandemic and was found to have a 42 cm parasitic leiomyoma attached to the small bowel causing obstruction and perforation. Conclusion Parasitic leiomyomas can cause small bowel obstruction and perforation. Parasitic leiomyomas can range in presentation from asymptomatic to sepsis. Parasitic leiomyomas can cause small bowel obstruction and perforation. Care should not be delayed in the setting of the COVID-19 pandemic.
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Affiliation(s)
- Anya Laibangyang
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Danbury Hospital, Danbury, CT, United States of America
| | - Cassandra Law
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Danbury Hospital, Danbury, CT, United States of America
| | - Gunjan Gupta
- Pathology & Laboratory Medicine, Danbury Hospital, Danbury, CT, United States of America
| | - Xiang Da Dong
- Department of Surgery, Nuvance Health, Danbury, CT, United States of America
| | - Linus Chuang
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Danbury Hospital, Danbury, CT, United States of America
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Inbag Morcellation Applied to the Laparoscopic Surgery of Leiomyoma: A Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6611448. [PMID: 34136570 PMCID: PMC8175161 DOI: 10.1155/2021/6611448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/13/2021] [Indexed: 11/21/2022]
Abstract
Objective To evaluate the efficacy and safety of an endoscopic bag during laparoscopic morcellation of leiomyoma or myomatous uterus. Materials and Methods A total of 48 patients with symptomatic leiomyoma were randomized for laparoscopic morcellation in two groups: group A with a specific endoscopic bag or group B without any bag. The primary outcome measure was the detection of smooth muscle cells from washing after power morcellation determined by peritoneal cytology and immunohistochemistry (IHC). Results Cytology and IHC from group A did not revealed any smooth muscle cells, while 29% of cases (7/24) from group B were positive (p = .009). The duration of the surgical procedure was the same in both groups. The duration of positioning the bag did not change significantly during the study. Only in one case the use of the bag was difficult due to a low pneumoperitoneum. Conclusions The use of a morcellation bag is efficient to prevent the spread of smooth muscle cells during the morcellation of leiomyoma or myomatous uterus. This study confirms the feasibility and the safety of the laparoscopic inbag morcellation versus open morcellation.
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17
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De Brakeleer E, Van Eeckhout E, Sahebali S, Cosyns S. Gigantic parasitic leiomyoma of 19 kg in a postmenopausal woman: A case report and review of the literature. J Obstet Gynaecol Res 2021; 47:2777-2781. [PMID: 34018284 DOI: 10.1111/jog.14854] [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: 12/08/2020] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/27/2022]
Abstract
Parasitic leiomyomas are a rare subtype of subserosal uterine leiomyomas and are mostly found incidentally. Diagnosis is challenging and treatment consists out of complete surgical resection. Cases are few in women without history of uterine surgery. In this extraordinary case, a 56-year-old menopausal female suffering from backache and abdominal swelling, was suspected to have a huge malignant ovarian tumor. She underwent a resection of the mass along with hysterectomy and bilateral salpingo-oöphorectomy. Histopathology revealed a gigantic leiomyoma of 19.1 kg in the broad ligament. This unique case suggests taking this diagnosis into account in future clinical cases presenting with large abdominal masses even without previous uterine surgery.
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Affiliation(s)
- Evy De Brakeleer
- Department of Gynecology, Universitair Ziekenhuis Brussel (UZBrussel), Brussels, Belgium
| | - Eddy Van Eeckhout
- Department of Gynecology, Universitair Ziekenhuis Brussel (UZBrussel), Brussels, Belgium
| | - Shaira Sahebali
- Department of Pathology, Universitair Ziekenhuis Brussel (UZBrussel), Brussels, Belgium
| | - Stefan Cosyns
- Department of Gynecology, Universitair Ziekenhuis Brussel (UZBrussel), Brussels, Belgium
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18
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Khan S, Sung YJ, Huang KG. Removing a Deeply Located, Cul De Sac, Large Retroperitoneal Leiomyoma Using Doyen's Screw: A Technical Challenge. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shazia Khan
- Department of Obstetrics and Gynecology, Army Hospital Research and Referral, New Delhi, India
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, at Linkou, Taoyuan, Taiwan
| | - Yen-Ju Sung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, at Linkou, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, at Linkou, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
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19
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Stebbings C, Latif A, Gnananandan J. Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain. BMJ Case Rep 2021; 14:14/1/e232797. [PMID: 33504515 PMCID: PMC7843348 DOI: 10.1136/bcr-2019-232797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.
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Affiliation(s)
| | - Ahmed Latif
- General Surgery, Lewisham and Greenwich NHS Trust, London, UK
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20
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Incidence of occult uterine sarcoma and other unexpected pathologies in patients having surgery for presumed myomas: A retrospective observational study. J Gynecol Obstet Hum Reprod 2020; 50:101992. [PMID: 33217603 DOI: 10.1016/j.jogoh.2020.101992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the incidence of occult uterine sarcomas and other unexpected pathologies in patients undergoing hysterectomies or myomectomies with a pre-operative diagnosis of uterine leiomyomas. STUDY DESIGN Retrospective study. SETTING Tertiary hospital in Santiago, Chile. POPULATION 921 women who underwent surgery for presumed myomas. Database analysis of surgical and pathological notes, from January 2007 to December 2017 with a preoperative diagnosis of uterine leiomyoma. MAIN OUTCOME MEASURES number of patients with uterine sarcoma confirmed on histology. RESULTS During this period, a total of 921 gynecological surgeries were performed for benign uterine fibroids of which 787 were hysterectomies and 134 were myomectomies. We found four cases of malignant neoplasms (0,43 %). Two were uterine leiomyosarcoma (LMS), one mixed epithelial and mesenchymal tumor, and one case of incidental cervical cancer. This gives an LMS incidence of 1 in 460 and 1 in 921 of mixed epithelial and mesenchymal tumor. There were seven cases of unexpected benign pathology. This included six atypical myomas and one leiomyoblastoma epithelioid myoma. If we combine the malignant and benign cases, we would have an incidence of 1.2 % of unexpected pathology. CONCLUSION In our series of patients undergoing myomectomies or hysterectomies for presumed myomas the incidence of LMS was 1 in 460. The incidence of any unexpected pathology including benign ones in presumed myomas was 1 in 83 (six atypical myomas, one leiomyoblastoma epithelioid myoma, two LMS, one mixed epithelial and mesenchymal tumor, one incidental cervical cancer).
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21
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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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22
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Dewulf K, Weyns V, Lelie B, Qasim H, Meersschaert J, Devos B. Ectopic leiomyoma as a late complication of laparoscopic hysterectomy with power morcellation: a case report and review of the literature. Acta Chir Belg 2020; 120:344-348. [PMID: 30892129 DOI: 10.1080/00015458.2019.1586396] [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] [Indexed: 01/28/2023]
Abstract
Introduction: Electromechanical power morcellation is a widely used technique to extract uterine fibroids during laparoscopic hysterectomy. Although the complication rate of morcellators is low, ectopic leiomyoma can appear several years after their use.Patients and methods: We present a case of an ectopic leiomyoma and a literature review of power morcellation-induced complications and ectopic leiomyoma.Results: A 49-year-old female presented with epigastric pain 12 years after laparoscopic subtotal hysterectomy with morcellation of the specimen. Radiological examinations revealed an epigastric mass of 45 mm that was laparoscopically removed. Histological examination confirmed the diagnosis of an ectopic leiomyoma. Complications of power morcellation are rarely reported and include perioperative injuries to bowel, vascular and urinary tract, spreading of ectopic leiomyoma and occult malignancy.Conclusions: Ectopic leiomyoma are a late and rare complication of a laparoscopic hysterectomy with power morcellation of the uterus.
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Affiliation(s)
- Karel Dewulf
- Department of Surgery, AZ Zeno, Knokke-Heist, Belgium
| | - Valerie Weyns
- Department of Surgery, AZ Zeno, Knokke-Heist, Belgium
| | - Bart Lelie
- Department of Pathology, AZ Zeno, Knokke-Heist, Belgium
| | - Hussain Qasim
- Department of Radiology, AZ Zeno, Knokke-Heist, Belgium
| | | | - Bart Devos
- Department of Surgery, AZ Zeno, Knokke-Heist, Belgium
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23
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Paredes C, Sagredo Y, Herrera F, Castillo I. Laparoscopic Resection of a Symptomatic Parasitic Leiomyoma of Paravesical and Obturator Fossa. J Minim Invasive Gynecol 2020; 28:1277. [PMID: 32890708 DOI: 10.1016/j.jmig.2020.08.485] [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: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To show laparoscopic management of a symptomatic parasitic leiomyoma of paravesical and obturator fossa. DESIGN Edited video demonstrating a step-by-step explanation of the surgical technique of this case. SETTING University hospital. INTERVENTIONS Uterine leiomyomas are the most common benign pelvic tumors in women. They occur in approximately 25% of women of reproductive age. Parasitic leiomyomas are rare, with few cases reported in the literature [1,2]. They are classified according to their location in relation to the myometrium. Parasitic leiomyomas are in group 8 of the International Federation of Gynecology and Obstetrics classification [3]. It is not clear why they are produced; it is thought that they could derive from subserous leiomyomas that achieved a blood supply from neighboring structures outside the uterus [1,3]. They can also have iatrogenic origin in patients who have undergone previous surgery such as myomectomy with power morcellation use [4]. We present the case of a 32-year-old women, gravida 1 para 1, without previous pelvic surgery. She complained of lower back and sacrum pain and nonspecific discomfort in her inner thigh. Her physical examination showed a 6- to 7-cm solid right paravaginal tumor. Ultrasonography and nuclear magnetic resonance confirmed the presence of a 7 × 5-cm solid tumor in the right paravesical and obturator fossa. The diagnosis of a probable parasitic myoma was proposed, and a laparoscopic resection was scheduled. The video demonstrates the surgical technique with special emphasis on the anatomy of the surgical site. The patient was discharged 24 hours after surgery without complications. The final pathology confirmed uterine leiomyoma. Written informed consent was requested according to the regulations of our institution. CONCLUSION A successful laparoscopic resection of a symptomatic parasitic leiomyoma of the paravesical and obturator fossa was achieved. The importance of knowledge of the pelvic anatomy for the management of this type of case is underlined.
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Affiliation(s)
- Cesar Paredes
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology (Drs. Paredes, Sagredo, and Herrera).
| | - Yesica Sagredo
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology (Drs. Paredes, Sagredo, and Herrera)
| | - Francisco Herrera
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology (Drs. Paredes, Sagredo, and Herrera)
| | - Ivan Castillo
- Department of Pathology (Dr. Castillo), Hospital de Talca, Universidad Catolica del Maule, Maule, Chile
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24
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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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25
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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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26
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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
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27
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Huge Primary Parasitic Leiomyoma in a Postmenopausal Lady: A Rare Presentation. Case Rep Obstet Gynecol 2019; 2019:7683873. [PMID: 31057977 PMCID: PMC6463606 DOI: 10.1155/2019/7683873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 03/03/2019] [Indexed: 11/19/2022] Open
Abstract
Although uterine myomas are the most common benign tumours of the female pelvis in the reproductive age group, they rarely grow in menopausal women. Parasitic fibroids without prior history of laparoscopic myomectomy are even a rarer presentation particularly in menopausal women. The case presented is a 58-year-old grand-multiparous, menopausal lady with progressive abdominal swelling of three-year duration. She had excision of a huge parasitic fibroid attached to omentum. She had partial omentectomy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy. The parasitic fibroid mass weighed 5.2kg and histopathology confirmed leiomyoma uteri with cystic degeneration and lymph nodes with reactive lymphoid hyperplasia. She had uneventful postoperative recovery and follow-up has so far been uneventful.
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28
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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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29
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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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30
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Bhargava P, Haque K, Vea R, Turbat-Herrera E, Chu Q, Sangster G, D'Agostino H. Parasitic leiomyoma presenting as an inguinal hernia in a postmenopausal woman. Radiol Case Rep 2018; 13:767-771. [PMID: 29887930 PMCID: PMC5991889 DOI: 10.1016/j.radcr.2018.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/08/2018] [Indexed: 12/03/2022] Open
Abstract
Uterine leiomyomas are one of the most common tumors affecting reproductive-age women. Leiomyomas can present as an intrauterine mass or rarely as an extrauterine tumor. Depending on its location, the diagnosis of extrauterine leiomyoma can be challenging, and multiple imaging modalities may be needed for correct identification and differentiation from malignant entities. We report the case of a 48-year-old-postmenopausal female who presented with a painful left inguinal mass, which was clinically diagnosed as inguinal hernia. Ultrasound, computed tomography, magnetic resonance imaging, and percutaneous biopsy were used to characterize the mass. Surgical resection and histopathological analysis revealed the mass to be a parasitic leiomyoma, a very rare cause of inguinal hernia, especially in a postmenopausal woman.
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Affiliation(s)
- Peeyush Bhargava
- Department of Radiology, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Kabiul Haque
- Department of Family Medicine, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Romulo Vea
- Department of Radiology, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Elba Turbat-Herrera
- Department of Pathology, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Quyen Chu
- Department of Surgery, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Guillermo Sangster
- Department of Radiology, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Horacio D'Agostino
- Department of Radiology, LSU Health, 1501 Kings Hwy, Shreveport, LA 71103, USA
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31
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Unusual Case of a Torted Mesenteric Fibroid. Case Rep Obstet Gynecol 2018; 2018:8342127. [PMID: 29977634 PMCID: PMC6011103 DOI: 10.1155/2018/8342127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/18/2018] [Indexed: 12/11/2022] Open
Abstract
Extrauterine leiomyomas are very rare and present a clinical and diagnostic challenge due to their unusual growth patterns and behaviours. A 47-year-old woman was transferred to our tertiary specialist obstetrics and gynaecology hospital with acute abdominal pain and a palpable abdominal mass. She was taken immediately to theatre with the presumptive diagnosis of an ovarian torsion. Intraoperatively, a large necrotic mass originating from the mesentery and attachments to the bowel at the ileocaecal junction was noted. When converted to laparotomy due to limited access and poor visualisation, the uterus, ovaries, and tubes were found to be normal. A right partial hemicolectomy was performed with the assistance of the colorectal surgeon due to suspicion of bowel malignancy. Histology revealed a benign infarcted leiomyoma with adhesions to the adjacent ileum. The diagnosis of a primary torted mesenteric fibroid was made.
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Zhang HM, Christianson LA, Templeman CL, Lentz SE. Non-malignant Sequelae after Unconfined Power Morcellation. J Minim Invasive Gynecol 2018; 26:434-440. [PMID: 29783003 DOI: 10.1016/j.jmig.2018.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVE To identify the incidence of repeat surgery and subsequent findings after the performance of unconfined uterine power morcellation. DESIGN A retrospective descriptive study (Canadian Task Force classification II-2). SETTING Southern California Kaiser Permanente Medical Centers. PATIENTS Women (N = 5154) who underwent laparoscopic supracervical hysterectomy with unconfined power morcellation. MEASUREMENTS AND MAIN RESULTS Of the 5154 cases, 279 (5.41%) underwent subsequent reoperation with a median of 24 months after index surgery. The most common clinical complaint leading to laparoscopic supracervical hysterectomy was symptomatic leiomyoma (n = 135, 48.4%) and abnormal uterine bleeding (n = 94, 33.7%). The most common indication for reoperation was a symptomatic adnexal mass (n = 87, 31.2%) followed by pelvic pain (n = 83, 29.7%). The majority (n = 128, 60.4%) of subsequent non-urogynecologic-related reoperations resulted in benign pathology. Endometriosis was the primary pathologic diagnosis in 65 of 279 (23.3%) of the reoperative cases; this was not previously documented in 86% (n = 57/65) of these cases. The overall frequency of subsequent pathology was endometriosis (65/5154, 1.26%), disseminated leiomyomatosis (18/5154, 0.35%), and new malignancy (11/5154, 0.21%). CONCLUSION Morcellation of nonmalignant tissue is not without consequence. Pathology confirmed endometriosis was documented for the first time in 20.4% of patients who underwent a second surgery. This finding raises the suspicion that morcellation and dispersion of the uterine specimen may be associated in the development of endometriosis.
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Affiliation(s)
- Hao M Zhang
- Department of Obstetrics, Gynecology and Reproductive Services, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California (Drs. Zhang and Christianson).
| | - Lee A Christianson
- Department of Obstetrics, Gynecology and Reproductive Services, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California (Drs. Zhang and Christianson)
| | - Claire L Templeman
- Divisions of Minimally Invasive and Pediatric Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California (Dr. Templeman)
| | - Scott E Lentz
- Gynecology Oncology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California (Dr. Lentz)
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Parasitic leiomyoma: A case report with literature review. Int J Surg Case Rep 2017; 41:33-35. [PMID: 29031175 PMCID: PMC5645485 DOI: 10.1016/j.ijscr.2017.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/01/2017] [Accepted: 10/01/2017] [Indexed: 11/27/2022] Open
Abstract
Parasitic leiomyoma is an extremely rare variant of uterine leiomyoma occurring outside uterus. Less than 30 reported cases have been reported in literature In line with. We report a case of parasitic leiomyoma occurring a in a middle age female without a brief review of literature.
Introduction Parasitic leiomyoma is an extremely rare variant of uterine leiomyoma occurring outside uterus. The aim of this study is to report a case of parasitic leiomyoma with brief literature report. Case report A 46-yearo-old lady presented with upper abdominal heaviness and swelling of about 6 year duration. associated with nausea, shortness of breath and palpitation. There was large well defined, mobile, hard mass in epigastric area measuring about 12 × 10 cm. Abdominal ultrasound showed well defined, solid, 94 × 76 mm, mass in the epigastric region. Abdominal computed tomography scan showed round homogenous opacity at the epigastric region with features consistent with benign lesion. Laparotomy was done, histopathological examination confirmed the diagnosis of parasitic leiomyoma. Conclusion Parasitic leiomyoma is an extremely rare subtype of uterine leiomyoma, presents with vague symptoms, diagnosed by ultrasound and managed by complete resection. Previous uterine procedures have been implicated in its etiology.
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34
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Benning H, Bernier M. Léiomyome parasitaire dans l'intestin grêle. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:836. [PMID: 28341343 DOI: 10.1016/j.jogc.2017.03.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Harbinder Benning
- Département d'obstétrique, de gynécologie et des sciences de la reproduction, Université du Manitoba, Winnipeg (Manitoba)
| | - Mark Bernier
- Département d'obstétrique, de gynécologie et des sciences de la reproduction, Université du Manitoba, Winnipeg (Manitoba)
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35
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A Parasitic Leiomyoma of the Small Bowel. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:835. [PMID: 28341342 DOI: 10.1016/j.jogc.2016.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/18/2016] [Indexed: 11/23/2022]
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36
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Taylan E, Sahin C, Zeybek B, Akdemir A. Contained Morcellation: Review of Current Methods and Future Directions. Front Surg 2017; 4:15. [PMID: 28352629 PMCID: PMC5348539 DOI: 10.3389/fsurg.2017.00015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/28/2017] [Indexed: 11/30/2022] Open
Abstract
Power morcellation of surgical specimen during laparoscopic surgery is a practical technology that provides the opportunity to perform several minimally invasive procedures. However, this technology brought forward additional risks and complications associated with dissemination of both benign and malignant tissues inside the abdominal cavity. Based on startling cases, Food and Drug Administration (FDA) announced a discouraging statement on the use of power morcellators that decreased the number of minimally invasive approaches in the following period. As a response to these concerns and negative impacts of the FDA statement, researchers developed several new approaches resulting in contained or in-bag morcellation methods. In this review, we aimed to discuss these current methods and provide an insight for future developments.
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Affiliation(s)
- Enes Taylan
- Laboratory of Molecular Reproduction and Fertility Preservation, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, New York Medical College, New York, NY, USA; Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Cagdas Sahin
- Department of Obstetrics and Gynecology, Ege University School of Medicine , Izmir , Turkey
| | - Burak Zeybek
- Department of Obstetrics and Gynecology, University of Texas Medical Branch , Galveston, TX , USA
| | - Ali Akdemir
- Department of Obstetrics and Gynecology, Ege University School of Medicine , Izmir , Turkey
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37
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Leiomyoma in the Retzius space. MENOPAUSE REVIEW 2017; 15:220-222. [PMID: 28250727 PMCID: PMC5327625 DOI: 10.5114/pm.2016.65668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/21/2016] [Indexed: 11/22/2022]
Abstract
Parauterine location of leiomyomas is observed to be an extremely rare clinical condition. However, when benign or malignant primary tumours are detected in that area, they are often found in the Retzius space. There have been only six cases of leiomyomas in the Retzius space reported in the literature so far. The paper presents one such leiomyoma case located in the Retzius space. This extremely rare location of the tumour justifies its presentation. The medical records of the patient treated in the outpatient’s obstetrics and gynaecology (ob-gyn) clinic, her case history, and hospital records, supplemented by information obtained from the patient’s daughter, were analysed. The patient, a 50-year-old woman with type 2 diabetes, was referred to hospital for diagnosed secondary anaemia due to heavy menstruation for four months, which was associated with intramural leiomyoma in the anterior wall of the uterine body. Clinical examination found a large leiomyoma located in the anterior wall of the uterus. Laparotomy was performed: apart from and a leiomyoma in the uterine body it found a tumour, 140 × 100 mm in size, in the Retzius space. Total resection of the tumour was performed. Since the leiomyoma was located in the uterine wall, hysterectomy with bilateral excision of adnexa was also performed. The patient was discharged home in generally good condition on the sixth day following the operation. Concomitant occurrence of leiomyoma atypically located in the Retzius space and leiomyoma in the uterine body made perioperative diagnosis very difficult.
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38
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Nezhat F, Apostol R, Greene AD, Pilkinton ML. To Morcellate or Not to Morcellate: A Cross-Sectional Survey Of Gynecologic Surgeons. JSLS 2017; 21:e2016.00092. [PMID: 28144125 PMCID: PMC5266514 DOI: 10.4293/jsls.2016.00092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The inadvertent dissemination of uterine cancer cells with the power morcellator has received much attention in the press and a warning from the U.S. Food and Drug Administration. Many hospitals prohibit the use of the morcellator in gynecologic surgery. We conducted a survey in an attempt to assess gynecologic surgeons' beliefs regarding the intracorporeal power morcellation of fibroids in light of the risk of dissemination of malignancy in patients in whom the presence of cancer is unknown before surgery. METHODS We conducted an Internet-based survey of 3505 members of the Society of Laparoendoscopic Surgeons (SLS) to assess demographics, current use of the intracorporeal power morcellator, and whether the recent negative press has affected gynecologic surgeons' use of the morcellator. RESULTS Of the 3505 SLS members surveyed, 518 responded (response rate, 14.77%). Three hundred thirteen (61%) of the respondents were not using the intracorporeal power morcellator. Of those, 48% reported the reason was a hospital-wide ban, and an additional 17% reported lack of availability (not in stock). Senior attendings with >20 years of experience used the morcellator more often than junior attendings and fellows (P = .007). Furthermore, the morcellator was used significantly less among those with the belief that morcellation of occult malignancy affects survival (P = .013). Three hundred sixty-one (76%) of the participants currently perform laparotomy in fewer than a quarter of their cases; most those cases are still performed using laparoscopic and robot-assisted techniques. CONCLUSION The recent negative press suggesting that intracorporeal power morcellation can disseminate occult malignancy and affect survival has decreased the use of the morcellator. Despite the declining use of power morcellation, most practicing gynecologic surgeons have not converted their procedures to laparotomy.
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Affiliation(s)
- Farr Nezhat
- Department of Obstetrics and Gynecology, Mt Sinai St Luke's and Roosevelt Hospital, New York, New York, USA
| | - Radu Apostol
- Department of Obstetrics and Gynecology, Mt Sinai St Luke's and Roosevelt Hospital, New York, New York, USA
| | - Alexis D Greene
- Department of Obstetrics and Gynecology, Mt Sinai St Luke's and Roosevelt Hospital, New York, New York, USA
| | - Marjorie L Pilkinton
- Department of Obstetrics and Gynecology, North Shore-Long Island Jewish Health System, Great Neck, New York, USA
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39
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Surgical Treatment of Uterine Fibroids Within a Containment System and Without Power Morcellation. Clin Obstet Gynecol 2016; 59:85-92. [PMID: 26670832 DOI: 10.1097/grf.0000000000000168] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Increased awareness regarding risks associated with intracorporeal electromechanical, or power, morcellation has urged surgeons to develop alternative methods for tissue extraction that may mitigate some of these risks during surgery. The use of containment systems during laparoscopic procedures has allowed surgeons to continue to offer and perform myomectomies that still benefit from being minimally invasive but which may minimize the risk of inadvertent tissue dispersion. Here, we will review techniques for performing contained tissue fragmentation without the use of a power morcellator.
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40
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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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41
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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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42
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Iida M, Ishikawa H, Shozu M. Spontaneous parasitic leiomyoma in a post-partum woman. J Obstet Gynaecol Res 2016; 42:1874-1877. [DOI: 10.1111/jog.13145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/19/2016] [Accepted: 07/23/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Mana Iida
- Department of Reproductive Medicine, Graduate School of Medicine; Chiba University; Chiba Japan
| | - Hiroshi Ishikawa
- Department of Reproductive Medicine, Graduate School of Medicine; Chiba University; Chiba Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Graduate School of Medicine; Chiba University; Chiba Japan
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43
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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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Lu B, Xu J, Pan Z. Iatrogenic parasitic leiomyoma and leiomyomatosis peritonealis disseminata following uterine morcellation. J Obstet Gynaecol Res 2016; 42:990-9. [PMID: 27125448 DOI: 10.1111/jog.13011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 01/31/2016] [Accepted: 02/26/2016] [Indexed: 12/16/2022]
Abstract
AIM To assess the impact of morcellation on the spread of uterine leiomyoma. METHODS Cases of parasitic leiomyoma involving prior laparoscopy were collected between 2012 and 2015 in a tertiary women's hospital in China. Their clinicopathological features and the associated reports were reviewed. RESULTS All six patients with parasitic leiomyoma had laparoscopic myomectomy or hysterectomy with power morcellation 39-132 months previously. Patient 1 had widely disseminated tumors in the peritoneum and pelvis, in keeping with leiomyomatosis peritonealis disseminata (LPD). She received debulking of peritoneal tumors and lived with disease for 22 months. The implanting sites of the other parasitic tumors (patients 2-6) included the mesentery (n = 2), intestine (n = 1), pelvic parietal (n = 1), bladder (n = 1), and musculus rectus abdominis (n = 1). The diameter varied from 1 cm to 6 cm. The patients underwent abdominal subtotal hysterectomy, cervicectomy or tumor debulking and the postoperative course was unremarkable for a period of 2-32 months. Pathologically, these disseminated or parasitic leiomyomas did not show any evidence of malignancy. There were no morphological or immunohistochemical differences between the original tumor and the following seeding tumors. On literature review, 11 iatrogenic LPD have been reported after laparoscopic surgery for uterine leiomyoma. These cases may provide an alternative pathogenic mechanism for a distinct variant of LPD. CONCLUSIONS Laparoscopic hysterectomy with tumor morcellation may increase the chance of tumor implantation and dissemination. Both clinicians and pathologists should be alert to this rare complication.
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Affiliation(s)
- Bingjian Lu
- Department of Surgical Pathology, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jing Xu
- Department of Surgical Pathology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Zimin Pan
- Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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El-Agwany AS, Fawzy Galal A. An Unusual Case of Retroperitoneal Pelvic Leiomyoma After Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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46
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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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Torsion of a parasitic myoma that developed after abdominal myomectomy. Obstet Gynecol Sci 2016; 59:75-8. [PMID: 26866042 PMCID: PMC4742482 DOI: 10.5468/ogs.2016.59.1.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/06/2015] [Accepted: 10/14/2015] [Indexed: 11/20/2022] Open
Abstract
Iatrogenic parasitic myomas are rare. The condition is defined by the presence of multiple smooth-muscle tumorous nodules in the peritoneal cavity. This may be attributable to seeding of myoma particles during uterine surgery. The clinical course is usually indolent. The disease is often asymptomatic and is usually discovered only incidentally. A 38-year-old woman who had undergone abdominal myomectomy 7 months prior presented with acute abdominal pain and a huge pelvic mass. We performed exploratory laparotomy. A parasitic mass 17 cm in diameter with a twisted omental pedicle was identified. En bloc excision of the mass and omentum was performed, followed by total abdominal hysterectomy. Histopathological examination of multiple sections revealed features compatible with an infarcted leiomyoma. Thus, we present a very rare case of an iatrogenic, rapidly growing parasitic myoma complicated by omental torsion (which caused the acute abdominal pain). We also offer a literature review.
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48
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Uncontained Compared With Contained Power Morcellation in Total Laparoscopic Hysterectomy. Obstet Gynecol 2016; 126:834-838. [PMID: 26348168 DOI: 10.1097/aog.0000000000001039] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare perioperative outcomes of uncontained and contained power morcellation in total laparoscopic hysterectomy. METHODS Women who underwent total laparoscopic hysterectomy that required utilization of power morcellation between July 2012 and January 2015 in the Division of Minimally Invasive Gynecology at an academic tertiary care center were included. In February 2014, the division began performing all power morcellation contained within a large insufflated bag in an attempt to reduce dissemination of benign and malignant uterine tissue. Data were collected from a prospective database and analyzed as a retrospective cohort. The primary outcome was operative time. Secondary outcomes included estimated blood loss, length of stay, pathology, uterine weight, and complications, including blood transfusion, conversion to open, intraoperative organ injury, pelvic infection, readmission, or reoperation. RESULTS A total of 152 patients were identified: 101 uncontained morcellations and 51 contained morcellations. The baseline demographic characteristics between the two groups were similar. Operative time was longer in the contained morcellation group (184 compared with 164 minutes, P=.01). There were no cases of visible bag disruption or dissemination of uterine tissue in the contained morcellation group. CONCLUSION Contained power morcellation at the time of total laparoscopic hysterectomy is associated with a 20-minute increase in operative time when compared with uncontained morcellation. LEVEL OF EVIDENCE II.
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First clinical experiences using a new in-bag morcellation system during laparoscopic hysterectomy. Arch Gynecol Obstet 2015; 294:83-93. [PMID: 26690354 DOI: 10.1007/s00404-015-3986-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/08/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Endoscopic techniques have successfully reduced the invasiveness of hysterectomy, when compared to open procedures. Power morcellation, as a part of the minimal invasive concept, carries the risk of disseminating cells from the tissue specimen. The present observational study reports on first experiences using a new system (More-Cell-Safe, A.M.I., Austria) for contained in-bag morcellation during laparoscopic hysterectomy. MATERIALS AND METHODS The dual opening system allows two-port access without bag puncture. The optic is protected against spread cell contamination with a disposable sleeve. Application data were prospectively recorded on the first n = 7 consecutive patients and compared to n = 7 preceding patients undergoing uncontained morcellation. RESULTS Bag system use was surgically successful in 6 of 7 cases (85.7 %). Morcellated specimen weight ranged from 205 to 638 g (mean 413.33 ± 176.85; median 413). In one patient, the uterine specimen (1050 g) proved too large to be placed into the bag. Average time associated to the bag use was 16.2 ± 7.65 min, ranging from 8.5 to 26.5 min (median 14 min). Removed bags contained bloody fluid with residual tissue fragments weighing overall between 21 and 85 g. Spread spindle cells were detected in two cases after uncontained morcellation, but not after in-bag morcellation. CONCLUSION The experiences from our small pilot series prove technical feasibility in the clinical setting.
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Grover A, Bhalla S. Parasitic leiomyoma: A rare complication following laparoscopic myomectomy with review of literature. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.cmrp.2015.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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