Leiomyomatosis peritonealis disseminate with formation of endometrial cysts within tumors arising after supracervical laparoscopic hysterectomy
ABSTRACT Use of morcellation during laparoscopic hysterectomy may result in seeding of uterine tissue throughout the abdominal cavity and development of 'iatrogenic' leiomyomatosis peritonealis disseminata.
Two years after a supracervical laparoscopic hysterectomy a 42-year-old parous women presented with abdominal pain and bloating. CT scans and subsequent surgical exploration reveled multiple solid tumors containing cysts filled with altered blood. Histologically the tumors had characteristic features of a benign leiomyoma with smooth muscle cells infiltrated by endometrial glands.
Pieces of smooth muscle cell and endometrial uterine tissue lost in the abdominal cavity during morcellation may progress to leiomyomatosis peritonealis disseminata with unusual appearance.
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ABSTRACT: Laparoscopic morcellation is frequently used for tissue removal after laparoscopic hysterectomy or myomectomy and may result in parasitic myomas, due to seeding of remained tissue fragments in the abdominal cavity. However, little is known about the incidence and risk factors of this phenomenon. To identify the incidence and risk factors for the development of parasitic myoma after laparoscopic morcellation. A systematic review of the literature in Pubmed (MEDLINE) and Embase was conducted. Reference lists of identified relevant articles were checked for missing case reports. Studies reporting on incidence or cases of parasitic myoma diagnosed after laparoscopic morcellation were selected. Studies were excluded when history of laparoscopic morcellation was lacking or final pathology demonstrated a malignancy or endometriosis. Data were extracted and analysed on incidence of parasitic myomas and characteristics of case reports. Fourty-four studies were included. Sixty-nine women diagnosed with parasitic myomas after laparoscopic morcellation were identified. Mean age was 40.8 (± 7.5) years (range 24-57), median time between surgery and diagnosis was 48.0 months (range 1-192) and mean number of parasitic myomas was 2.9 (± 3.3) (range 1-16). The overall incidence of parasitic myomas after laparoscopic morcellation was 0.12-0.95%. Although the incidence is relatively low, it is important to discuss the risk of parasitic myoma after laparoscopic morcellation with women and balance towards alternative treatment options. The duration of steroid exposure after laparoscopic morcellation might be a risk factor for development of parasitic myomas. Systematic review on the incidence and risk factors for parasitic myoma after laparoscopic morcellation. © 2015 Royal College of Obstetricians and Gynaecologists.BJOG An International Journal of Obstetrics & Gynaecology 07/2015; DOI:10.1111/1471-0528.13541 · 3.86 Impact Factor