Iatrogenic Parasitic Leiomyomas: A Late and Uncommon Complication After Laparoscopic Morcellation

Panesar, Harrypal; Dhaliwal, Harjit S

doi:10.7759/cureus.24718

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…Van der Meulen et al [39] reported an overall incidence of parasitic myomata of 0.12-0.95% in 69 cases (mean age 40.8 ± 7.5 years; range 24-57) from 44 studies reviewed, with a median time between surgery and diagnosis of 48.0 months (range 1-192) and a mean number of parasitic myomas of 2.9 ± 3.3 (range 1-16). Parasitic leiomyomatosis produces late symptoms, which is why it is diagnosed several years after its inoculation or when a tumor-related complication appears [40][41][42][43]. In our series, 10 patients presented with parasitic myomata; all of them had had previous myoma surgery.…”

Section: Discussionmentioning

confidence: 75%

The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation

Devassy

Wilde

et al. 2023

JCM

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Contained electromechanical morcellation has emerged as a safety approach for laparoscopic myomatous tissue retrieval. This retrospective single-center analysis evaluated the bag deployment practicability and safety of electromechanical in-bag morcellation when used for big surgical benign specimens. The main age of patients was 39.3 years (range 21 to 71); 804 myomectomies, 242 supracervical hysterectomies, 73 total hysterectomies, and 1 retroperitoneal tumor extirpation were performed. A total of 78.7% of specimens weighed more than 250 g (n = 881) and 9% more than 1000 g. The largest specimens, weighing 2933 g, 3183 g, and 4780 g, required two bags for complete morcellation. Neither difficulties nor complications related to bag manipulation were recorded. Small bag puncture was detected in two cases, but peritoneal washing cytology was free of debris. One retroperitoneal angioleiomyomatosis and three malignancies were detected in histology (leiomyosarcoma = 2; sarcoma = 1); therefore, patients underwent radical surgery. All patients were disease-free at 3 years follow-up, but one patient presented multiple abdominal metastases of the leiomyosarcoma in the third year; she refused subsequent surgery and was lost from follow-up. This large series demonstrates that laparoscopic bag morcellation is a safe and comfortable method to remove large and giant uterine tumors. Bag manipulation takes only a few minutes, and perforations rarely occur and are easy to detect intraoperatively. This technique did not result in the spread of debris during myoma surgery, potentially avoiding the additional risk of parasitic fibroma or peritoneal sarcoma.

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Section: Discussionmentioning

confidence: 75%

The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation

Devassy

Wilde

et al. 2023

JCM

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“…Pathogenesis of benign metastasising (or parasitic) ULs is barely studied. There are assumptions that UL metastases might occur as a complication after laparoscopic surgery due to the morcellation of myomas and even that UL metastasising points towards the underestimated malignant potential of the initial tumour [ 229 , 230 , 231 , 232 ]. Regardless of UL metastasising mechanism, this phenomenon raises the need to update UL classification criteria as well as criteria to distinguish benign and malignant tumours.…”

Section: Spectrum Of Somatic Genetic Aberrations In Ul Cellsmentioning

confidence: 99%

A View on Uterine Leiomyoma Genesis through the Prism of Genetic, Epigenetic and Cellular Heterogeneity

Koltsova

Efimova

Pendina

2023

IJMS

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Uterine leiomyomas (ULs), frequent benign tumours of the female reproductive tract, are associated with a range of symptoms and significant morbidity. Despite extensive research, there is no consensus on essential points of UL initiation and development. The main reason for this is a pronounced inter- and intratumoral heterogeneity resulting from diverse and complicated mechanisms underlying UL pathobiology. In this review, we comprehensively analyse risk and protective factors for UL development, UL cellular composition, hormonal and paracrine signalling, epigenetic regulation and genetic abnormalities. We conclude the need to carefully update the concept of UL genesis in light of the current data. Staying within the framework of the existing hypotheses, we introduce a possible timeline for UL development and the associated key events—from potential prerequisites to the beginning of UL formation and the onset of driver and passenger changes.

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A parasitic leiomyoma of the sigmoid mesentery with schwannoma-like image findings

Fujiwara,

Takagi,

Sato

et al. 2024

surg case rep

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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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Iatrogenic Parasitic Leiomyomas: A Late and Uncommon Complication After Laparoscopic Morcellation

Cited by 5 publications

References 19 publications

The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation

The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation

A View on Uterine Leiomyoma Genesis through the Prism of Genetic, Epigenetic and Cellular Heterogeneity

A parasitic leiomyoma of the sigmoid mesentery with schwannoma-like image findings

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