腹腔鏡下に診断治療した腹腔内遊離子宮筋腫の1例

Abstract

Uterine leiomyomas are commonly encountered benign gynecologic tumors. However, cases of extrauterine leiomyomas are relatively rare and often present diagnostic challenges. We report a case of an acute abdomen caused by an extrauterine leiomyoma that was completely isolated from other organs and was laparoscopically diagnosed. A 39-year-old woman gravida 4 para 4 with a history of a fist-sized uterine myoma at the age of 30 years, was admitted to our hospital because of the acute onset of right lower abdominal pain. The patient had undergone a cesarean section for placenta previa six days before admission. Transvaginal ultrasound revealed a 7.3 × 6.1 cm solid tumor and the physical examination revealed tenderness at the right lower abdomen. Torsion of a subserosal leiomyoma or right ovarian tumor was suspected; therefore, laparoscopic surgery was performed for diagnosis and treatment. Both adnexa were found to be normal-sized, and a tumor completely isolated from surrounding structures was observed. The postoperative histopathologic diagnosis was leiomyoma. Cases of parasitic leiomyomas after laparoscopic myomectomy associated with morcellation are increasingly being reported. In contrast, cases of spontaneous parasitic leiomyomas remain extremely rare because the origins of the tumors are unknown. This case was considered to be a pedunculated subserosal myoma that had spontaneously separated from the uterus and was found prior to parasitization to other organs. Therefore, this case demonstrates a natural pathogenic mechanism of a spontaneous parasitic leiomyoma.