Parasitic Leiomyoma: A Rare Occurrence Following Robotic Hysterectomy

Abstract

<h3>Study Objective</h3> To highlight the presentation and management of a symptomatic parasitic leiomyoma after a robotic assisted hysterectomy for a multi-fibroid uterus. <h3>Design</h3> Case report. <h3>Setting</h3> Lithotomy, Trendelenburg positioning. <h3>Patients or Participants</h3> C.B. is a 36-year-old G0. <h3>Interventions</h3> Index surgery – Robotic-assisted total laparoscopic hysterectomy and bilateral salpingectomy with mini-laparotomy 1. Robotic-assisted laparoscopic removal of pelvic mass <h3>Measurements and Main Results</h3> C.B. is a 36-year-old G0 who desired definitive management of a symptomatic multi-fibroid uterus. Preoperative ultrasound and MRI displayed an enlarged multi-fibroid 18-week uterus with a dominant 9cm fundal fibroid. Leuprolide acetate was administered for 6 months pre-operatively to reduce the myoma size and anticipated intra-operative blood loss. She underwent a robotic-assisted total laparoscopic hysterectomy and bilateral salpingectomy. A myomectomy was concurrently performed with diathermy to remove an obstructing fibroid for aid in visualization. A mini laparotomy was made to remove the surgical specimen, which was unable to be delivered through vagina. Pathology was benign. C.B. presented one year postoperatively with pelvic pain and bulk symptoms. Her exam was consistent with an adnexal mass and MRI revealed a 6cm pelvic mass. C.B. underwent a robotic-assisted laparoscopic removal of the mass, which was attached to the vaginal cuff. Pathology revealed an infarcted leiomyoma. She followed up postoperatively with complete resolution of her symptoms. <h3>Conclusion</h3> This case highlights a rare occurrence of a parasitic leiomyoma following a hysterectomy. There has been no publication to date describing the occurrence of parasitic myomas after concomitant myomectomy and hysterectomy without morcellation. The authors speculate that seeding of cells during the myomectomy may have been responsible for the development of a parasitic myoma; however, further investigation is needed. This case report also emphasizes the importance of being mindful of the occurrence of parasitic fibroids in a post-hysterectomy patient presenting with pain and pelvic mass.