An Extremely Rare Case of Disseminated Peritoneal Leiomyomatosis with a Pelvic Leiomyosarcoma and Omental Metastasis after Laparoscopic Morcellation: Systematic Review of the Literature

Parasitic Leiomyoma at Laparoscopic Trocar Site: A Report of 2 Cases

BACKGROUND Parasitic leiomyoma refers to leiomyomas outside the uterus, with a prevalence of 0.07%. Patients are initially asymptomatic and may later develop abdominal pain and abdominal distension. Parasitic leiomyomas at a trocar site are extremely rare and lack detailed reporting. Here, we report 2 cases of parasitic leiomyoma at trocar sites. CASE REPORT Case 1. The patient was a 47-year-old woman with parasitic leiomyomas at a left trocar site 4 years after laparoscopic total hysterectomy. After being diagnosed with 3 masses on the surface of the sigmoid colon and 2 in the pelvic cavity, the patient underwent laparoscopic removal of a pelvic lesion and 3 lesions on the surface of the colon, combined with excision of abdominal wall masses. The pathology result indicated that the masses at the left trocar site were multiple leiomyomas, the intestinal mass was multiple leiomyomas with abundant cells, and the pelvic mass was fibrous capsule parietal tissue. This patient received 3 months of gonadotropin-releasing hormone agonist (GnRH-a) treatment, and was followed up for 9 months without recurrence. Case 2. The patient was a 50-year-old woman with parasitic leiomyoma at the right trocar site 15 years after laparoscopic removal of the right ovarian cyst. At admission, she underwent transabdominal total hysterectomy, bilateral fallopian tube resection, and abdominal wall lesion resection. The pathology report showed multiple leiomyomas of the uterus, and the cell-rich parasitic leiomyoma at right trocar site with unclear boundary. She received 3 months of GnRH-a treatment, and was followed up for 6 months without recurrence. CONCLUSIONS For patients with a history of laparoscopy, gynecologists should be alert to the occurrence of parasitic leiomyoma.

Intraperitoneal spread in uterine sarcoma following unprotected laparoscopic transvaginal uterine morcellation: a case report and literature review

Clinically and through auxiliary examinations, distinguishing uterine leiomyoma from early-stage uterine sarcoma presents significant challenges. A 48-year-old patient underwent a laparoscopic hysterectomy for uterine leiomyoma, during which a large uterus was excised through the vagina and extracted. Four months post-operation, the patient developed abdominal distension, indicative of extensive pelvic-abdominal dissemination of uterine sarcoma. We hypothesize that unprotected fibroid fragmentation increases the risk of uterine sarcoma spread, thereby worsening the prognosis. Our literature review aims to thoroughly understand the risks associated with unprotected transvaginal laparoscopic tumor division.

Disseminated Peritoneal Leiomyomatosis-A Challenging Diagnosis-Mimicking Malignancy Scoping Review of the Last 14 Years

Disseminated peritoneal leiomyomatosis (DPL) is a rare condition marked by multiple leiomyomas in the peritoneal cavity, predominantly affecting women of reproductive age. Although typically benign, DPL can present significant diagnostic challenges and, in rare cases, may progress to malignancy. A primary contributing factor to DPL is iatrogenic, particularly due to surgical interventions such as morcellation during myomectomy. This scoping review explores the pathogenesis, epidemiology, diagnosis, and management of DPL, highlighting the crucial role of hormonal influences and iatrogenic factors. Diagnostic methods include computed tomography, ultrasound, magnetic resonance imaging, and histopathological evaluation, which are essential for assessing disease extent and guiding treatment. Management strategies encompass surgical intervention-with a focus on minimizing iatrogenic risks-conservative approaches for asymptomatic patients, and advancements in hormonal treatments. Emphasis is placed on preventing iatrogenic dissemination through refined surgical techniques and patient education. Despite its rarity, with fewer than 200 cases reported globally, understanding DPL's clinical presentation and iatrogenic origins is vital for optimal patient outcomes. This review underscores the importance of early diagnosis, personalized treatment plans, and ongoing research to address the challenges associated with DPL.

Rapidly evolving pelvic lymphangioleiomyomatosis (LAM) mimicking bilateral hydrosalpinx: report of a rare case and literature review

Lymphangioleiomyomatosis (LAM) represents a rare neoplasm affecting almost exclusively women of reproductive age. This condition mainly affects the lungs, but extrapulmonary locations such as the pelvis and the retroperitoneum are possible. Clinical evaluation and ultrasound imaging are usually non-specific, and the diagnosis is obtained through surgical excision and histopathological examination. We report a very rare case of abdominal LAM in a young female patient. A thorough literature review of this rare condition with emphasis on gynecologic implications will be presented. The patient was referred for gynecologic consultation due to pelvic pain and infertility. Unfortunately, despite prompt diagnosis and treatment, the course of the disease was severe and led to patient's exitus in a short time. We encountered an extremely rare deadly pathology mimicking a very common gynecologic condition. The gynecologist must always be alert of possible unexpected conditions that will require prompt attention.

Uterine smooth muscle tumors: a multicenter, retrospective, comparative study of clinical and ultrasound features

OBJECTIVE

To evaluate a wide range of clinical and ultrasound characteristics of different uterine smooth muscle tumors to identify features capable of discriminating between these types.

METHODS

This was a retrospective, multicenter study that included 285 patients diagnosed with uterine smooth muscle tumors (50 leiomyosarcomas, 35 smooth muscle tumors of uncertain malignant potential, and 200 leiomyomas). The patients were divided into three groups based on the histological type of their tumors, and the groups were compared according to the variables collected.

RESULTS

Leiomyosarcomas were more common in older and post-menopausal women. Compared with leiomyomas, smooth muscle tumors of uncertain malignant potential and leiomyosarcomas had similar ultrasound features such as absence of normal myometrium, multilocular appearance, hyper-echogenicity in case of uniform echogenicity, absence of posterior shadows, echogenic areas, and hyperechoic rim. Leiomyosarcomas were larger, had more cystic areas, and were associated with a higher prevalence of pelvic free fluid. Smooth muscle tumors of uncertain malignant potential were characterized by a higher frequency of International Federation of Gynecology and Obstetrics (FIGO) type 6-7, the absence of internal shadows, and, in the case of cystic area, the presence of a regular internal wall. Tumor outline varied among the three histological types. A color score of 1 was typical of leiomyoma, a color score 2 was mainly observed in leiomyomas and smooth muscle tumors of uncertain malignant potential, a color score 3 did not differ among the tumors, while a color of score 4 was related to leiomyosarcomas. When combining color scores 3 and 4, leiomyosarcomas and smooth muscle tumors of uncertain malignant potential showed a high percentage of both circumferential and intra-lesional vascularization. A cooked appearance was not statistically different among the tumors.

CONCLUSIONS

Based on our findings, specific ultrasonographic features as well as age and menopausal status are associated with different uterine smooth muscle tumor types. Integration of these data can help the pre-operative assessment of these lesions for proper management.