Parasitic Pelvic and Infradiaphragmatic Leiomyomatosis Following Laparoscopic Myomectomy

Abstract

Purpose: Uterine leiomyomas are the most common indication for gynecological surgery. The use of power morcellators has facilitated myomectomy, but appears to be associated with leiomyoma seeding, leading to parasitic leiomyomatosis. This is a case report of a patient with parasitic leiomyomatosis following laparoscopic myomectomy, which was detected incidentally during elective gallbladder surgery. Case Report: A 42-year-old female was treated for symptomatic cholelithiasis in July 2018 by elective laparoscopic cholecystectomy. Three years earlier, the patient had undergone laparoscopic myomectomy using a power morcellator for the removal of a subserosal uterine fibroid 21 cm in diameter. During laparoscopy, a firm nodule, roughly 2 cm in diameter was observed on the right infradiaphragmatic surface, and two smaller, similar pelvic nodules. The infradiaphragmatic nodule was excised and histopathological examination identified it as leiomyoma tissue, confirming the case as parasitic leiomyomatosis. Discussion: Parasitic leiomyomatosis is a rare entity first described in 1909. Reports of its incidence have increased since the advent of laparoscopic surgery for the treatment of uterine fibroids and there appears to be an association with the use of power morcellators for fragmentation of large myomas, which may promote seeding. Parasitic myoma cells display increased expression of estrogen and progesterone receptors, and increased angiogenetic capacities compared with their uterine counterparts. Further studies are required to ascertain whether power morcellators play a key role in myoma dissemination, and to evaluate possible therapeutic solutions.