Iatrogenic Parasitic Leiomyoma in the Lower Right Abdomen: A Rare Case in Plastic Surgery.

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.

Acute abdomen by red degeneration of a parasitic leiomyoma: A case report and literature review.

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.

Parasitic leiomyoma of the greater omentum: a case report and literature review.

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.

Case report Iatrogenic parasitic leiomyoma: the surgeon's invisible hand.

Uterine leiomyoma is the most common benign tumour of the uterus in women of reproductive age. When removed surgically, a mini-invasive procedure is preferentially used (laparoscopic or robotic) and the extraction of the specimen can be managed by power morcellation. In this consecutive case-series, we present three cases of parasitic leiomyoma that appeared following previous surgical management of leiomyoma using the technique of laparoscopic myomectomy with uncontained power morcellation. The time frame in between the initial surgery and the diagnosis of the parasitic leiomyoma was 5.7 years. All three patients were diagnosed with endometriosis: 2 cases prior to the initial surgery and 1 case after the initial surgery. One hypothesis could be that, due to pelvic inflammation, endometriosis is a risk factor for iatrogenic parasitic leiomyoma development in case of uncontained morcellation of leiomyoma during myomectomy.

Unusual Case of a Parasitic Extra-Uterine Leiomyoma Presenting With Lower Abdominal Pain.

Parasitic fibroids are a rare type of extrauterine benign tumors that may be spontaneous or iatrogenic in origin and often difficult to diagnose due to their various presentations. We report an unusual case of a parasitic leiomyoma in a 33-year-old nulliparous woman with remote pelvic history who presented to our institution with sudden-onset lower abdominal pain. We performed an exploratory laparotomy, which revealed a 6.3x4.6 cm mass in the space of the adnexa of the right parametrium. Histopathological examination revealed features compatible with a leiomyoma. It is clear that physicians need to assess clinical findings and imaging techniques in order to establish a correct diagnosis of parasitic myomas, even when a history of myomectomy or a laparoscopic morcellation is absent.

Parasitic Leiomyoma as a Cause for Primary Small Bowel Obstruction.

Parasitic leiomyomas (PL) are rare cause of small bowel obstruction (SBO) in young women. Usually, they arise in women who underwent laparoscopic or surgical morcellation of uterine fibroids. PL may present with vague abdominal pain, constipation, obstipation, or rarely SBO. SBO can be primary or secondary, depending on prior surgical history. PL might present as primary SBO due to their mass effect or secondary SBO if the patient's PL resulted from a surgical procedure. We came across a very remarkable presentation of primary SBO due to an artery supplying the PL. Few cases of primary PL have been reported.

Parasitic leiomyoma in the trocar site after laparoscopic myomectomy: A case report.

BACKGROUND: Laparoscopic myomectomy is increasingly used for resecting gynecological tumors. Leiomyomas require morcellation for retrieval from the peritoneal cavity. However, morcellated fragments may implant on the peritoneal cavity during retrieval. These fragments may receive a new blood supply from an adjacent structure and develop into parasitic leiomyomas. Parasitic leiomyomas can occur spontaneously or iatrogenically; however, trocar-site implantation is an iatrogenic complication of laparoscopic uterine surgery. We describe a parasitic leiomyoma in the trocar-site after laparoscopic myomectomy with power morcellation. CASE SUMMARY: A 50-year-old woman presented with a palpable abdominal mass without significant medical history. The patient had no related symptoms, such as abdominal pain. Computed tomography findings revealed a well-defined contrast-enhancing mass measuring 2.2 cm, and located on the trocar site of the left abdominal wall. She had undergone laparoscopic removal of uterine fibroids with power morcellation six years ago. The differential diagnosis included endometriosis and neurogenic tumors, such as neurofibroma. The radiologic diagnosis was a desmoid tumor, and surgical excision of the mass on the abdominal wall was successfully performed. The patient recovered from the surgery without complications. Histopathological examination revealed that the specimen resected from the trocar site was a uterine leiomyoma. CONCLUSION: Clinicians should consider the risks and benefits of laparoscopic vs laparotomic myomectomy for gynecological tumors. Considerable caution must be exercised for morcellation to avoid excessive tissue fragmentation.

Parasitic fibroid of greater omentum in 31-years old woman.

Uterine leiomyomas are the most common benign tumors of the uterine smooth muscle. The latest FIGO classification, considering both their location and the degree of ingrowth into the uterine muscle, distinguishes eight classes of fibroids [1]. The location of leiomyomas in connection with their size may determine the characteristic symptoms: abdominal pain, pressure symptoms, difficulties in getting pregnant, recurrent miscarriages. Among the case reports there are also descriptions of the so-called parasitic leiomyomas [2]. The paper presents a case report of a parasitic leiomyoma in a young woman who has not been operated on in the abdominal or pelvic organs so far.

Leiomioma parasitario retroperitoneal: reporte de un caso / Retroperitoneal parasitic leiomioma: A case report

Resumen ANTECEDENTES: Los leiomiomas parasitarios son una variante poco común de la miomatosis uterina. Se han identificado en la pared abdominal, intestino delgado, muñón cervical o vaginal, vasos iliacos, ovarios, colon sigmoides y en el omento mayor. OBJETIVO: Reportar un caso clínico de leiomioma parasitario retroperitoneal y revisar la bibliografía al respecto. CASO CLÍNICO: Paciente de 57 años, con diagnóstico de NIC-III y hemorragia uterina anormal. Acudió a consulta debido a una sensación de masa y dolor abdominal, pérdida de peso subjetiva, hiporexia, disfagia y plenitud gástrica de cuatro meses de evolución. En los estudios de extensión se documentó una masa retroperitoneal grande y elevación de los marcadores tumorales Ca 125 y Ca 19-9. La resección de la masa se efectuó mediante laparotomía, con hallazgo histopatológico de mioma parasitario. CONCLUSIÓN: Los leiomiomas parasitarios deben considerarse en el diagnóstico diferencial de pacientes con antecedente de histerectomía o miomectomía, sobre todo en el contexto de la morcelación. El tratamiento consiste en cirugía o inhibidores de la aromatasa y análogos de la hormona liberadora de gonadotropina (leiomiomatosis peritoneal diseminada).

Abstract BACKGORUND: Parasitic leiomyomas are a rare entity, defined as an unusual variant of uterine myomatosis. Have been documented in the abdominal wall, small intestine, cervical or vaginal stump, iliac vessels, ovaries, sigmoid colon, and greater omentum. OBJECTIVE: To report a clinical case of retroperitoneal parasitic leiomyoma and review the literature. CLINICAL CASE: A 57-year-old patient with a diagnosis of CIN-III and secondary abnormal uterine bleeding, who consulted for a sensation of abdominal mass and pain, subjective weight loss, hyporexia, dysphagia and gastric fullness, of four months of evolution. Extension studies document a large retroperitoneal mass and elevation of tumor markers Ca 125 and Ca 19-9. We practice surgical management of her gynecological pathology and resection of the mass by laparotomy, with histopathological finding of myoma. CONCLUSION: Parasitic leiomyomas should be suspected in patients with a detected mass and a history of hysterectomy or myomectomy, especially in the context of morcellation. The treatment of this condition is surgical and, in cases of disseminated peritoneal leiomyomatosis, pharmacological treatments have been used with aromatase inhibitors and gonadotropin-release hormone analogues.

An Intraluminal Parasitic Leiomyoma of the Sigmoid Colon and Potential Pathogenetic Mechanisms.

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.

Leiomyomatosis peritonealis disseminata mimicking peritoneal carcinomatosis 13 years after laparoscopic uterine myomectomy: A case report.

INTRODUCTION: Leiomyomatosis peritonealis disseminata (LPD) is a rare clinical condition that can be challenging to diagnose because its clinical features mimic other conditions. We present a case of LPD mimicking peritoneal carcinomatosis 13 years after laparoscopic uterine myomectomy using a power morcellator. The aim of this paper is to report a rare case which surgeons can learn from and to provide more clinical information for further studies to investigate LPD. PRESENTATION OF CASE: A 49-year-old woman was referred to us because sonography revealed abnormal abdominal and pelvic nodules. Thirteen years previously, she had undergone laparoscopic uterine myomectomy using a power morcellator. An exploratory laparotomy revealed nodules on the peritoneum, greater omentum, intestinal mesentery, and terminal ileum. We surgically removed all visible nodules and performed bilateral salpingo-oophorectomy. LPD was confirmed based on the morphology and immunohistochemistry results. DISCUSSION: Diagnosing LPD preoperatively may be difficult because its clinical manifestations resemble peritoneal carcinomatosis or metastatic lesions. Abdominal pain due to diffuse tumor growth is a common manifestation. LPD degenerating into malignancy is rare, but possible. The probable etiological factors, clinical manifestations, and treatment options which may aid when dealing with LPD have been described in this report. CONCLUSION: LPD should be considered in women, particularly those with a history of gynecologic surgery presenting with disseminated intraabdominal or pelvic tumors.

The exceptional case of a large extra-uterine, so-called parasitic leiomyoma in a post-menopausal woman with Hashimoto's thyroiditis.

A large tumour mass was detected in a 65-year-old patient during a routine gynaecological examination. This patient had been treated for over 10 years with levothyroxine for Hashimoto's thyroiditis and was also given transdermal oestrogen replacement therapy. Before the operation, detailed imaging by CT scan and MRI was performed. A tumour weighing 1.056 grams and measuring 23x12x7 cm was successfully removed through laparotomy. Histopathology revealed the diagnosis of an extra-uterine, so-called parasitic leiomyoma. Post-surgery recovery was uneventful, but Tibolone treatment was indicated due to disturbing menopausal complaints.

Parasitic leiomyoma - a case report and review of the literature.

OBJECTIVE: The aim of this study is to report a case of parasitic leiomyoma in a brief literature report. CASE REPORT: A 40-year-old woman was repeatedly examined for chronic abdominal pain in 2020. Lesions presented on CT images showed suspicion of carcinomatosis or endometriosis. Her past history is a laparoscopic myomectomy and hysteroscopic transcervical resection of myoma. CONCLUSION: Parasitic leiomyoma or leiomyomatosis peritonealis disseminata is an extremely rare variant of uterine leiomyoma occurring outside the uterus. According to the International Federation of Gynecology and Obstetric classification, parasitic leiomyoma has been classified as type 8. Previous laparoscopic myomectomy with intraperitoneal morcellation has been implicated in its etiology. The most common symptom - if present, is abdominal pain, pressure, bloating during eating or nausea.

Port-site implantation of parasitic leiomyoma after laparoscopic myomectomy and its histopathology.

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.

Non-malignant Sequelae after Unconfined Power Morcellation.

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.

Disseminated peritoneal leiomyomatosis: a devastating sequelae of unconfined laparoscopic morcellation.

There has been growing concern surrounding the use of unconfined power morcellation in laparoscopic surgeries for uterine leiomyoma due to its associated risks and long-term clinical sequelae, including parasitic leiomyomas and disseminated peritoneal leiomyomatosis (DPL). We present a case of DPL resulting from previous laparoscopic morcellation and a review of the existing literature. DPL is a potentially devastating consequence of unconfined laparoscopic morcellation in the surgical management of uterine fibroids. A multidisciplinary approach is recommended in the management of DPL, especially in cases of multivisceral involvement. Clinical caution ought to be exercised when using power morcellators; when unavoidable, confined laparoscopic morcellation offers a promising mitigation and should be adopted if practicable.

Port site parasitic leiomyoma after laparoscopic myomectomy: a case report and review of the literature.

BACKGROUND: Uterine fibroids are the commonest benign gynecological tumors. Laparoscopic myomectomy is becoming increasingly popular as one of the surgical treatment options for symptomatic cases. Large tissues such as leiomyomas or even the uterus need to be morcellated in order to be retrieved from the abdominal cavity. Some of the morcellated fragments or small fibroids may be accidentally left in the abdominal cavity during the retrieval process. These may subsequently become implanted in the abdominal cavity, develop blood supply from the surrounding structures, and grow to form parasitic myomas with varied clinical presentation, depending on the location and size. CASE PRESENTATION: A 47-year-old African woman presented to our hospital 6 years after laparoscopic myomectomy with a lower abdominal mass. Her work-up revealed an anterior abdominal wall mass consistent with uterine leiomyoma. She was scheduled for excision of the mass, which was subsequently histologically confirmed to be a uterine fibroid. CONCLUSIONS: Parasitic leiomyomas are a rare late complication of power morcellation following laparoscopic myomectomy or hysterectomy. Most patients present with an abdominal/pelvic mass and may need surgical excision to relieve the symptoms. Care should be taken during power morcellation to prevent excessive fragmentation of the tissues, some of which may become implanted and persist to form parasitic myomas. Moreover, effort should be made to retrieve all myoma fragments by carefully checking the abdominal cavity. Whenever possible, the morcellation should be done in a containment bag.

Malignant transformation of uterine leiomyoma to myxoid leiomyosarcoma after morcellation associated with ALK rearrangement and loss of 14q.

A 50 year old woman underwent laparoscopic supracervical hysterectomy because of symptomatic fibroids. Histologic examination of samples obtained after morcellation revealed typical uterine leiomyomas in all samples investigated. 28 and 47 months later, respectively, the patient presented with peritoneal spreading of nodules that were surgically removed and histologically classified as leiomyosarcoma. In 3/4 of samples obtained after morcellation copy number/SNP-array hybridization showed complex genomic alterations widely identical to the pattern characterizing the sarcoma. Therefore, we conclude that the leiomyosarcoma had unambiguously developed from one of the leiomyomas as a result of secondary genetic alterations i.e. a rearrangement of ALK and a del(14q). The case is challenging the current risk estimates for spreading of unexpected malignant uterine tumors due to power morcellation and highlights the relevance of certain genetic alterations for rare malignant transformation of uterine benign smooth muscle tumors.

Parasitic leiomyoma presenting as an inguinal hernia in a postmenopausal woman.

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.