1
|
Murakami K, Kitade M, Kumakiri J, Takeuchi S, Kawasaki Y, Ochiai A, Yanagihara Y, Itakura A. Incidence and risk factors of parasitic myoma after laparoscopic myomectomy using uncontained power morcellation: Retrospective analysis of 87 patients who had a subsequent second laparoscopic surgery. J Obstet Gynaecol Res 2024. [PMID: 39318245 DOI: 10.1111/jog.16098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 09/12/2024] [Indexed: 09/26/2024]
Abstract
AIM Studies on parasitic myomas after laparoscopic morcellation are mainly limited to case reports, and the incidence and risk factors have not yet been well-understood. We aimed to clarify the actual incidence and risk factors of parasitic myoma after laparoscopic myomectomy using uncontained power morcellation by reviewing cases with subsequent laparoscopic surgery. METHODS This retrospective study included 87 patients who had laparoscopic myomectomy using uncontained power morcellation, followed by subsequent second laparoscopic surgery for gynecological disease between 2008 and 2021. First, the incidence and characteristics of parasitic myomas detected at the second laparoscopic surgery were reviewed. Second, patients were stratified according to the presence of parasitic myoma (PM+ and PM- groups), and risk factors were analyzed by comparing the background, intraoperative findings, and clinical course after laparoscopic myomectomy. RESULTS Of the 87 patients, parasitic myomas were detected in 16 (18.4%). Twelve patients (75.0%) were asymptomatic and diagnosed incidentally during surgery. Two patients presented with acute abdomen requiring emergency surgery. Comparing the PM+ and PM- groups, the total weight of the enucleated myomas and the diameter of the largest myoma at the initial laparoscopic myomectomy were significantly greater in the PM+ group. Other factors, including age and number of enucleated myomas did not differ between the groups. CONCLUSIONS The actual incidence of parasitic myoma after laparoscopic myomectomy using uncontained power morcellation is higher than that previously reported. In laparoscopic power morcellation, large myomas increase the risk of developing parasitic myoma, and a containment bag system is expected to minimize this complication.
Collapse
Affiliation(s)
- Keisuke Murakami
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Jun Kumakiri
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shiori Takeuchi
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yu Kawasaki
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Asako Ochiai
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yasuho Yanagihara
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Yoshida R, Makihara Y, Miyamoto A, Araki H, Ando S, Yoshizako T, Oride A, Kaji Y. Acute abdomen by red degeneration of a parasitic leiomyoma: A case report and literature review. Radiol Case Rep 2024; 19:1533-1536. [PMID: 38317695 PMCID: PMC10839770 DOI: 10.1016/j.radcr.2024.01.031] [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: 12/30/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
A 43-year-old woman, with a history of uterine fibroids and multiple myomectomy, presented with acute lower abdominal pain. Computed tomography revealed multiple tumors, including a high-density mass in the left lower abdomen indicative of a parasitic leiomyoma undergoing red degeneration. This uncommon condition is due to acute occlusion, often caused by peripheral venous thrombosis at the fibroid edge. The diagnosis was corroborated by distinctive findings on magnetic resonance imaging and computed tomography. Notably, high signal intensity on T1-weighted images (T1WI) suggested methemoglobin presence due to hemorrhagic infarction, whereas low signal intensity on T2-weighted images (T2WI) indicated deoxyhemoglobin. Symptom improvement followed treatment with analgesics. This case underscores the significance of considering parasitic myomas in the differential diagnosis of intraperitoneal tumors after myomectomy and proposes that vascular torsion from mechanical stress on the mobile mesentery may contribute to red degeneration in such tumors. In this report, we detail the imaging characteristics and clinical progression of red degeneration in a parasitic leiomyoma, emphasizing the importance of this diagnosis in patients with a history of uterine surgery.
Collapse
Affiliation(s)
- Rika Yoshida
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Yuko Makihara
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Akina Miyamoto
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Hisatoshi Araki
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Shinji Ando
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Takeshi Yoshizako
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Aki Oride
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Enya-cho, 89-1, Izumo 693-8501, Shimane, Japan
| | - Yasushi Kaji
- Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| |
Collapse
|
4
|
Panesar H, Dhaliwal HS. Iatrogenic Parasitic Leiomyomas: A Late and Uncommon Complication After Laparoscopic Morcellation. Cureus 2022; 14:e24718. [PMID: 35676984 PMCID: PMC9166603 DOI: 10.7759/cureus.24718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/05/2022] Open
Abstract
Parasitic leiomyoma (PL) is an extremely rare variant of uterine leiomyomas that occurs outside of the uterus and can often present like intra-abdominal tumors. The aim of this study is to report a case of PL and compare it with current literature. We present a rare case of a 45-year-old female who presented with bloating and spasmodic abdominal cramps for a two-month duration. She had a previous laparoscopic myomectomy six years ago. Transvaginal ultrasound (TVUS) showed solid vascular masses in the pelvis, the largest being 6 cm. Computed tomography (CT) of the thorax, abdomen, and pelvis (CTTAP) revealed further peritoneal masses in the left paracolic gutter suggesting peritoneal distant metastasis. Laparoscopy was completed, and biopsy and histopathological examination confirmed the diagnosis of parasitic leiomyoma. The patient opted for a bilateral salpingo-oophorectomy (BSO) creating iatrogenic menopause. One-year follow-up CT showed a reduction in the size of fibroids. PL can present with vague symptoms, typically nonspecific abdominal pain and cramping. It can often be confused with intra-abdominal tumors. It should be suspected in patients with previous uterine procedures. Histopathological examination is crucial for diagnostic and surgical management.
Collapse
Affiliation(s)
- Harrypal Panesar
- Otolaryngology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR
| | - Harjit S Dhaliwal
- Department of Obstetrics and Gynaecology, Royal Bournemouth Hospital, Bournemouth, GBR
| |
Collapse
|
5
|
Kai K, Aoyagi Y, Nishida M, Arakane M, Kawano Y, Narahara H. Port-site implantation of parasitic leiomyoma after laparoscopic myomectomy and its histopathology. SAGE Open Med Case Rep 2020; 8:2050313X20959223. [PMID: 32995003 PMCID: PMC7502794 DOI: 10.1177/2050313x20959223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/26/2020] [Indexed: 01/08/2023] Open
Abstract
Although parasitic leiomyoma could be spontaneous or iatrogenic in origin, port-site implantation of parasitic leiomyoma is an iatrogenic benign sequela of laparoscopic surgery. A 30-year-old, primigravida Japanese woman was referred after unresponsiveness to preoperative gonadotropin-releasing hormone for intramural fibroids. Magnetic resonance imaging showed multiple intramural fibroids and left ovarian endometrioma with no malignant features. Laparoscopic myomectomy with power morcellation and ovarian cystectomy were performed, followed by treatment with a combined oral contraceptive. Seven years after the primary surgery, she underwent abdominal myomectomy for a port-site, and peritoneal recurrence of the leiomyoma and intramural leiomyomas was detected. Microscopic examination revealed that resected specimens from the port-site demonstrated leiomyoma with lesser cell density and more prominent hyalinization than those from the uterus. Therefore, clinicians should counsel patients regarding the risks and benefits of laparoscopy with morcellation versus laparotomy. Further development of techniques for uterine tissues extraction is warranted.
Collapse
Affiliation(s)
- Kentaro Kai
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yoko Aoyagi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Masakazu Nishida
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Motoki Arakane
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yasushi Kawano
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Hisashi Narahara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| |
Collapse
|
6
|
Darii N, Anton E, Doroftei B, Ciobica A, Maftei R, Anton SC, Mostafa T. Iatrogenic parasitic myoma and iatrogenic adenomyoma after laparoscopic morcellation: A mini-review. J Adv Res 2019; 20:1-8. [PMID: 31080671 PMCID: PMC6505034 DOI: 10.1016/j.jare.2019.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 02/05/2023] Open
Abstract
Laparoscopy is widely recognized as a procedure of choice for gynaecological surgery. Myomectomy and hysterectomy are the most frequently performed surgical procedures in gynaecology. A morcellator is often used in myomectomies or subtotal hysterectomies, but morcellation may cause rare complications, such as parasitic iatrogenic myoma or adenomyoma. To improve patient counselling, proper risk estimation as well as risk factor identification should be acknowledged. This article aimed to review the literature on parasitic myoma and adenomyoma and to compare these diseases in terms of clinical, surgical, and prognostic factors. All published literature (case series and case reports) on iatrogenic myoma and adenomyoma was reviewed using PubMed/MEDLINE and ScienceDirect resources. Despite both conditions having an iatrogenic origin, iatrogenic parasitic myoma and adenomyoma are two different entities in terms of clinical manifestations as well as intraoperative particularities, with a common point: iatrogenic complication. A possible solution to avoid these iatrogenic complications is by using in-bag morcellation or switching to another surgical procedure (e.g., a vaginal or abdominal approach). It is concluded that parasitic myoma and iatrogenic adenomyoma are two different iatrogenic morcellator-related complications. In patients with a history of uterus or myoma morcellation who report pelvic symptoms, iatrogenic parasitic myoma or adenomyoma should be considered in the differential diagnosis.
Collapse
Affiliation(s)
- Natalia Darii
- Department of Gynecology, Cuza Voda Hospital, University of Medicine and Pharmacology Gr T Popa, 700038 Iasi, Romania
| | - Emil Anton
- Department of Gynecology, Cuza Voda Hospital, University of Medicine and Pharmacology Gr T Popa, 700038 Iasi, Romania
| | - Bogdan Doroftei
- Department of Gynecology, Cuza Voda Hospital, University of Medicine and Pharmacology Gr T Popa, 700038 Iasi, Romania
| | - Alin Ciobica
- Department of Research, Faculty of Biology, Alexandru Ioan Cuza University, B dul Carol I, 700506, no 11, Iasi, Romania
| | - Radu Maftei
- Department of Gynecology, Cuza Voda Hospital, University of Medicine and Pharmacology Gr T Popa, 700038 Iasi, Romania
| | - Sorana C. Anton
- “Grigore T.Popa” University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
| | - Taymour Mostafa
- Department of Andrology and Reproduction, Faculty of Medicine, Cairo University, Al-Saray Street, El Manial Cairo 11956, Egypt
| |
Collapse
|
7
|
Gerashchenko AV, Filonenko TG, Golubinskaya EP, Kalfa MA, Kriventsov MA. Morcellation-Induced Leiomyomatosis Peritonealis Disseminata: A Rare Case Report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2019; 44:60-64. [PMID: 30666077 PMCID: PMC6330526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Leiomyomatosis peritonealis disseminata (LPD) is a benign disease characterized by the presence of multiple small nodules on the omentum, parietal, and visceral peritoneum. It corresponds to leiomyoma and often resembles metastases of malignant tumors; however, with favorable prognosis. Here we describe a 46-year-old woman, diagnosed with LPD, to demonstrate the etiopathogenesis of the developed leiomyomatosis following endoscopic extirpation of the uterus with the use of a power morcellator. The patient was operated for diffuse leiomyoma using a power morcellator. Six months later, during a follow-up visit, disseminated tumor nodes on the peritoneum were revealed. Histological and immunohistochemical (smooth muscle α-actin, vimentin, estrogen receptors, progesterone receptors, and Ki67) study confirmed the diagnosis of LPD. As part of the follow-up, certain regression of the tumor nodes was noted against the backdrop of the onset of menopause and the corresponding decline of estrogen levels. Currently, the prognosis is favorable and follow-up is ongoing. Such cases are rare, but the condition is particularly important due to its iatrogenic nature. It has attracted the attention of the Food and Drug Administration (FDA) because power morcellation is probably associated with the risk of spreading suspected cancerous tissue. The existing high risk of iatrogenic LPD formation indicates the need for detailed reporting of all similar clinical cases, including the established pathogenetic and pathomorphological mechanisms of this process to prevent morcellator-related complications.
Collapse
|
8
|
Wen KC, Sung PL, Chang WH, Horng HC, Chen YJ, Lee WL, Wang PH. A case-control study to compare the outcome of women treated by two minimally invasive procedures-ultraminilaparotomy myomectomy and laparoscopic myomectomy. Taiwan J Obstet Gynecol 2018; 57:264-269. [DOI: 10.1016/j.tjog.2018.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2018] [Indexed: 12/26/2022] Open
|
9
|
Estrogen Effects on Wound Healing. Int J Mol Sci 2017; 18:ijms18112325. [PMID: 29099810 PMCID: PMC5713294 DOI: 10.3390/ijms18112325] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/30/2017] [Accepted: 11/02/2017] [Indexed: 02/07/2023] Open
Abstract
Wound healing is a physiological process, involving three successive and overlapping phases—hemostasis/inflammation, proliferation, and remodeling—to maintain the integrity of skin after trauma, either by accident or by procedure. Any disruption or unbalanced distribution of these processes might result in abnormal wound healing. Many molecular and clinical data support the effects of estrogen on normal skin homeostasis and wound healing. Estrogen deficiency, for example in postmenopausal women, is detrimental to wound healing processes, notably inflammation and re-granulation, while exogenous estrogen treatment may reverse these effects. Understanding the role of estrogen on skin might provide further opportunities to develop estrogen-related therapy for assistance in wound healing.
Collapse
|
10
|
Hong MK, Chu TY, Wang JH, Ding DC. Two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy: An initial experience. Tzu Chi Med J 2017; 29:165-170. [PMID: 28974911 PMCID: PMC5615997 DOI: 10.4103/tcmj.tcmj_61_17] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To report our initial experience with and the short-term outcomes of two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy (LESS-CLSH). MATERIALS AND METHODS A retrospective case study included 40 women who underwent LESS-CLSH from January 2014 to December 2016 at Buddhist Tzu Chi General Hospital. Uterine specimens were extracted through contained manual morcellation with a tissue pouch. The first phase was LESS supracervical hysterectomy and conization of the internal orifice of the cervix. The second phase was transvaginal cervical conization and cylinderization. Women with a uterus diameter of >12 cm, a broad ligament myoma, or severe pelvic adhesion were categorized into a difficult group, and others were categorized into a nondifficult group. RESULTS The difficult group required more time and had more blood loss than the nondifficult group. The mean surgical time was 187.2 ± 33.9 and 139.1 ± 20.7 min, and the mean blood loss was 533.3 ± 333.3 and 225.3 ± 168.2 mL in the difficult and nondifficult groups, respectively. The overall visual analog scale (VAS) pain scores at 0-4, 24, and 48 h after surgery were 7.1 ± 1.9, 4.2 ± 1.6, and 2.3 ± 1.5, respectively; no difference in the VAS pain scores, pain relief score, and hospitalization duration was observed between the two groups. Minor surgical complications or adverse events on follow-up were noted. Three months after surgery, the diameter and thickness of the cervix were decreased by approximately 0.5 and 1.0 cm, respectively. CONCLUSION LESS-CLSH is a minimally invasive, safe, and feasible approach, even for difficult laparoscopic hysterectomy. Contained manual morcellation enables more controlled specimen removal than morcellation only.
Collapse
Affiliation(s)
- Mun-Kun Hong
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.,Minimally Invasive Gynecology Surgery Center, Buddhist Tzu Chi Hospital, Hualien, Taiwan
| | - Tang-Yuan Chu
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.,Minimally Invasive Gynecology Surgery Center, Buddhist Tzu Chi Hospital, Hualien, Taiwan
| | - Jen-Huang Wang
- Department of Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.,Minimally Invasive Gynecology Surgery Center, Buddhist Tzu Chi Hospital, Hualien, Taiwan
| |
Collapse
|
11
|
Mynbaev OA, Malvasi A, Simakov SS, Tinelli A. Comment on "Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation". Reprod Biol Endocrinol 2017; 15:54. [PMID: 28732545 PMCID: PMC5521111 DOI: 10.1186/s12958-017-0268-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cause of contamination and dissemination of leiomyoma tissue particles and cells in the peritoneal cavity during myomectomy is a challenging issue for both clinicians and researchers. Therefore, the article by Huang et al. recently published in your journal is the subject of this letter. MAIN BODY We comment on the role of laparoscopic condition in xenograft implantation and also highlighted the shortcomings of this study. The surgical technique of intramural fibroid enucleation, cell spillage during morcellation and postsurgical hormonal impact on the development of parasitic myomas become evident, while the contribution of CO2 insufflation, the fibroid's nature, mutations and pseudocapsule impacts on angiogenesis are not clear. In addition, an exploration of the exact origin of implanted fragments harvested from the fibroid tissue and their nature might play a significant role in the implantation and the angiogenesis induction ability of xenografts. CONCLUSION Taking into account the current literature in the scope of this study, we suggest that the factors involved in development of parasitic myomas can be classified as confirmed and doubtful contributions.
Collapse
Affiliation(s)
- Ospan A. Mynbaev
- 0000 0000 9559 0613grid.78028.35Division of Molecular Technologies, Research Institute of Translational Medicine, N.I.Pirogov Russian National Research Medical University, Ostrovitianova str. 1, Moscow, 117997 Russia
- 0000 0001 2192 9124grid.4886.2Institute of Numerical Mathematics, RAS, Moscow, Russia
| | - Antonio Malvasi
- 0000 0004 1785 3878grid.415208.aDepartment of Obstetrics and Gynecology, Santa Maria Hospital. G.V.M. Care and Research, Bari, Italy
| | - Sergei S. Simakov
- 0000 0001 2192 9124grid.4886.2Institute of Numerical Mathematics, RAS, Moscow, Russia
| | - Andrea Tinelli
- 0000 0004 1769 6825grid.417011.2Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Piazza Muratore, Lecce, Italy
| |
Collapse
|
12
|
Huang BS, Horng HC, Wang PH, Yang MH, Chen YJ. Response to comment on "Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation". Reprod Biol Endocrinol 2017; 15:55. [PMID: 28732509 PMCID: PMC5521145 DOI: 10.1186/s12958-017-0270-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 06/17/2017] [Indexed: 11/10/2022] Open
Abstract
According to the literature review, CO2 insufflation on parasitic myoma implantation is not well studied, and we concur that our study is related to "Morcellation-induced parasitic myomas." We did not compare CO2 insufflation to non-insufflation in our study. The reason is the efficacy of gasless laparoscopic myomectomy and morcellation is not well established and this modality is seldom performed. Moreover, the effects of pneumoperitoneum on mesothelial cells and the role of the entire peritoneal cavity as a cofactor in adhesion formation have become well established, the role of CO2 insufflation in the establishment of parasitic myomas has not yet been studied. As such, more in-depth and well-designed studies for the role of CO2 insufflation are needed.
Collapse
Affiliation(s)
- Ben-Shian Huang
- 0000 0004 0604 5314grid.278247.cDepartment of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- 0000 0004 1767 1097grid.470147.1Department of Obstetrics and Gynaecology, National Yang-Ming University Hospital, No.152, Xin-Min Road, Yilan, 260 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- 0000 0001 0425 5914grid.260770.4Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Huann-Cheng Horng
- 0000 0004 0604 5314grid.278247.cDepartment 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, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Peng-Hui Wang
- 0000 0004 0604 5314grid.278247.cDepartment 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, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- 0000 0001 0425 5914grid.260770.4Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Muh-Hwa Yang
- 0000 0001 0425 5914grid.260770.4Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Yi-Jen Chen
- 0000 0004 0604 5314grid.278247.cDepartment 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, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- 0000 0001 0425 5914grid.260770.4Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- 0000 0004 0572 7890grid.413846.cDepartment of Obstetrics and Gynaecology, Cheng-Hsin General Hospital, No.45, Cheng Hsin St., Pei-Tou, Taipei Taiwan
| |
Collapse
|
13
|
Is Laparoscopic Power Morcellation of Fibroids a Cardinal Sin in 2017? J Obstet Gynaecol India 2017; 67:1-6. [PMID: 28242959 DOI: 10.1007/s13224-017-0970-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 12/21/2022] Open
Abstract
The diagnosis of an unsuspected leiomyosarcoma after hysterectomy for the treatment of a presumed benign leiomyoma is a rare but highly clinically significant event. In order to facilitate removal of large uterine specimens using a minimally invasive surgical approach, morcellation with extraction in pieces is often performed. In the event of unsuspected malignancy, this may result in abdominal dispersion of the tumor and contribute to poorer survival. Modern surgical innovations always work toward improving minimally invasive strategies. Laparoscopy, rooted in practices for years, supplanted laparotomy for many indications. For extraction of large uteri, morcellation is currently the only way to externalize surgical specimens (myomas, uteri), without increasing the skin opening while allowing to reduce postoperative complications when compared to laparotomy. However, in 2014, the Food and Drug Administration warned against the use of uterine morcellation because of an oncological risk. Some practicing academicians have challenged this recommendation. The incidence of uterine sarcomas is still poorly identified and preoperative diagnostic facilities remain inadequate. The small number of retrospective studies currently available do not reinforce any recommendation. The evaluation of morcellation devices and the improvement of preoperative diagnostic modalities (Imaging, preoperative Biopsy) are being improvised continually so as to minimize the oncological risks. Even during conventional myomectomy, tissue spillage occurs during resection of leiomyoma(s). Adverse oncologic outcomes of tissue morcellation should be mitigated through improved patient selection, preoperative investigations, and novel techniques that minimize tissue dispersion. Preoperative endometrial biopsy and cervical assessment to avoid morcellation of potentially detectable malignant and premalignant conditions is recommended.
Collapse
|
14
|
Takeda A, Hayashi S, Teranishi Y, Imoto S, Nakamura H. Portomesenteric Vein Thrombosis After Excision of Parasitic Peritoneal Myomas. J Minim Invasive Gynecol 2016; 24:501-505. [PMID: 27939898 DOI: 10.1016/j.jmig.2016.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 11/26/2016] [Accepted: 11/30/2016] [Indexed: 12/16/2022]
Abstract
An enlargement of multiple asymptomatic pelvic masses was detected during a regular checkup of a 39-year-old woman. Twelve years earlier, she had undergone laparoscopic-assisted myomectomy, at which time an uncontained manual extraction of a posterior intramural myoma was performed. This was followed by 2 uneventful cesarean deliveries after spontaneous conceptions. Diagnostic imaging revealed at least 3 abdominal masses, 1 of which received its major blood supply from the inferior mesenteric artery. Gasless single-port laparoscopic excision of the peritoneal masses, was performed along with laparoscopic-assisted vaginal hysterectomy and bilateral salpingo- oophorectomy. The masses were histopathologically diagnosed as parasitic peritoneal myomas. The patient's immediate postoperative course was uneventful; however, on day 6 after surgery, she complained of severe periumbilical abdominal pain and vomiting. Anticoagulant therapy was initiated after hematologic examination revealed an elevated D-dimer level and dynamic computed tomography angiography showed portomesenteric vein thrombosis. Vaginal stump bleeding, which occurred 17 days after the initiation of anticoagulant therapy, was managed conservatively, and there was no recurrence of venous thrombosis in the year after surgery. To avoid significant morbidities and potential mortality when parasitic peritoneal myomas with aberrant neovascularization are excised, attention should be given to the perioperative development of venous thromboembolic events in rare locations.
Collapse
Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
| | - Shotaro Hayashi
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Yoshie Teranishi
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Sanae Imoto
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| |
Collapse
|