History Of Laparoscopic Myomectomy Research Articles

A parasitic leiomyoma of the sigmoid mesentery with schwannoma-like image findings

BackgroundParasitic leiomyoma (PL) consists of uterine fibroids separate from the uterus that grow in extrauterine tissues such as the peritoneum and mesenterium. The diagnosis of PL requires a thorough medical history of laparoscopic myomectomies using a morcellator and the identification of typical magnetic resonance imaging (MRI) findings as uterine fibroids. Imaging diagnosis of PL is occasionally difficult when PL degenerates in various ways, owing to atypical findings on computed tomography (CT) and MRI.Case presentationA 29-year-old woman with a history of laparoscopic myomectomy visited a local hospital with lower abdominal pain. A mesenteric tumor on the sigmoid mesentery was suspected on MRI, and she was referred to our hospital. CT scan showed strong early contrast uptake in the center of the tumor, and MRI T2-weighted images showed high signals at the tumor margins and low signals in the center, suggesting a schwannoma. PL was also part of the differential diagnosis because of the patient’s history of laparoscopic myomectomy. With a preoperative diagnosis of a sigmoid colon mesenteric tumor undeniably of malignant origin, laparoscopic resection of the sigmoid mesenteric tumor was performed. Histopathological examination revealed it to be a PL.ConclusionsWe report a case of PL of the sigmoid mesentery with schwannoma-like findings on imaging that was treated laparoscopically. PL is sometimes difficult to distinguish from schwannomas because of the variety of imaging findings, such as uterine fibroids. PL should be considered in the differential diagnosis of mesenteric tumors following laparoscopic myomectomies, even if it does not show typical imaging findings, such as uterine fibroids.

Pregnancy outcomes and associated factors for uterine rupture: an 8\u2009years population-based retrospective study

BackgroundUterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. The aim of this study was to assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after caesarean section (VBAC), and the maternal and perinatal implications.MethodsThis is a population-based retrospective study. All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their information retrieved from the medical records department were reviewed retrospectively.ResultsA total of 209,112 deliveries were included and 41 cases of uterine rupture were identified. The incidence of uterine rupture was 1.96/10000 births. Among the 41 cases, 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal fatality related to uterine rupture was 7.3%. Among all cases, 38 (92.7%) were scarred uterus and 3 (7.3%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section, while cases with a history of laparoscopic myomectomy were more likely to have serious adverse outcomes, such as fetal death. 24 (59.0%) of the ruptures occurred in anterior lower uterine segment. Changes in Fetal heart rate monitoring were the most reliable signs for rupture.ConclusionsIncidence of uterine rupture in the study area, Shanghai, China was consistent with developed countries. Further improvements in obstetric care and enhanced collaboration with referring health facilities were needed to ensure maternal and perinatal safety.

Leiomyomatosis Peritonealis Disseminata Following Laparoscopic Surgery With Uncontained Morcellation: 13 Cases From One Institution.

Objectives: To investigate the clinical characteristics, treatment and prognosis of leiomyomatosis peritonealis disseminata (LPD) following laparoscopic surgery with uncontained morcellation and to summarize clinical features of iatrogenic LPD based on published literature together with our own experience.Methods: A cohort of 13 cases with iatrogenic LPD diagnosed and treated in Peking Union Medical College Hospital from 2011 to 2020 was reported focusing on clinical characteristics, treatment and prognosis.Results: All the patients had a history of laparoscopic myomectomy with uncontained morcellation. The average age was 35.6 (range 25–47) years. The interval between initial laparoscopic surgery and first diagnosis of LPD was 6.08 years on average (range 1–12). Most of the patients had no obvious symptoms. The accuracy of pre-operative diagnosis was low. Two patients had been treated with gonadotropin-releasing hormone agonist (GnRH-a) before surgery without obvious effect. The nodules of LPD are usually located in the lower half of the peritoneal cavity. The most commonly involved site was the pouch of Douglas. The number of nodules ranged from 3 to over 10, and they ranged in size ranged from 0.3 to 22 cm. All patients underwent surgical treatment: six patients underwent laparoscopy and seven underwent laparotomy. Pathology results confirmed LPD. The immunohistochemical profile indicated LPD tends to be positive strongly for desmin, caldesmon, ER, PR and SMA. Only one patient underwent post-operative treatment with GnRH-a. All patients were followed for an average period of 49 months without recurrence.Conclusion: Iatrogenic LPD is a relatively rare condition. Patients usually exhibit no hormonal stimulation factors. Surgery is the main method of treatment, and hormone suppressive therapy is only rarely used. The nodules are usually large and less numerous, and most involve the pelvis. The prognosis of iatrogenic LPD seems good.

Uterine Leiomyosarcoma: A Case Report

<p>本文報告一位41歲女性，因持續兩週的下腹悶痛及腫塊求診，術後確診為子宮平滑肌惡性肉瘤，她在兩年半前曾接受腹腔鏡子宮肌瘤切除術，診斷為非典型子宮肌瘤。子宮平滑肌惡性肉瘤的發生率極低，目前超音波及電腦斷層尚無法和子宮肌瘤明確區分，而核磁共振是一個相當敏感的工具，因此若腫瘤超過8 cm或生長快速，宜進一步以核磁共振或以組織切片或直接手術探查。此外，非典型子宮肌瘤，雖多數為良性，但有進展為惡性肉瘤的可能，建議在術後至少5年內，每半年接受骨盆腔理學檢查，每年胸部X光攝影及骨盆腔影像學檢查，以早期發現復發或惡性的腫瘤。</p> <p> </p><p>We herein reported a 41-year-old woman presenting with two weeks of lower abdominal mass and dull pain. She underwent total hysterectomy with bilateral salpingo-oophorectomy, and the pathology examination revealed uterine leiomyosarcoma. The patient had a surgical history of laparoscopic myomectomy with a pathologic diagnosis of atypical leiomyoma of the uterus two and a half years ago.</p> <p>The incidence of uterine leiomyosarcoma is very low. In the modern era, echography and computed tomography remain unable to clearly differentiate uterine leiomyosarcoma from leiomyoma, whereas MRI is a sensitive tool for diagnosis. Therefore, if a lower abdominal mass is more than 8 cm or rapidly growing, MRI, biopsy, or laparoscopic exploration, is strongly recommended. Moreover, while atypical leiomyoma of the uterus is mostly benign in nature, it has a high rate of recurrence and the potential of transformation into leiomyosarcoma. Hence, for early detection of recurrence, pelvic examination twice a year, annual chest X-ray, and pelvic imaging are recommended for at least 5 years postoperatively in these cases.</p> <p> </p>

Risk factors and outcomes of uterine rupture in Singapore: Emerging trends

Uterine rupture is uncommon but has catastrophic implications on the pregnancy. A scarred uterus and abnormal placentation are known contributory factors. The aim of our study was to review the contributing factors, clinical presentation, complications and management of uterine rupture in our population in light of the changing nature of modern obstetric practices. A retrospective observational study was conducted at KK Women's and Children's Hospital by studying proven cases of uterine rupture in the period between January 2003 and December 2014. These cases were analysed according to their past history, clinical presentation, complications, management and outcome. A total of 48 cases of proven uterine rupture were identified. The incidence of uterine rupture was 1 in 3,062 deliveries. The ratio of scarred uterus rupture to unscarred uterus rupture was approximately 3:1. The most common factor was previous lower segment caesarean section for the scarred group, followed by a history of laparoscopic myomectomy. Abdominal pain was the common clinical presentation in the antenatal period, while abnormal cardiotocography findings were the most common presentation in intrapartum rupture. There is a notable shift in the trend of uterine rupture cases given the increasing use of laparoscopic myomectomy and elective caesarean sections. While ruptures from these cases were few, their presentation in the antenatal period calls for diligent monitoring with informed patient involvement in their pregnancy care.

Giant Parasitic Fibroid Mimicking Gist: A Clinical Dilemma

ABSTRACTBackgroundParasitic fibroids are a rare type of fibroids without direct uterine attachment. They pose a diagnostic dilemma and often present atypically.Case descriptionWe report a rare case of large secondary parasitic fibroid in a 24 year unmarried female who presented with history of lump abdomen for 6 months. She had history of laparoscopic myomectomy done 2.5 years back for the same complaint with histopathology report suggestive of leiomyoma. On examination, it was found to be subserosal pedunculated fibroid. All the tumor markers were negative except CA 125 which was 225 IU/mL. Exploratory laparotomy was done. Uterus was normal size and seen separately. Bilateral tubes and ovaries were normal. A mass of size 30 × 22 × 15 cm, firm in consistency occupying all the quadrants of abdomen, was observed. It had no attachment to the uterus or to the bowel. Mass weighing 6.5 kg was removed completely and sent for histopathology. HPE report confirmed leiomyoma. Her postoperative period was uneventful.ConclusionIf the patient had prior history of myomectomy and mass is separate from the uterus with its blood supply away from uterus, diagnosis of parasitic leiomyoma should be considered.Clinical significanceDuring morcellation procedures, a thorough inspection and washing of peritoneal cavity must be carried out, and endoscopic bag should be used to prevent secondary parasitic leiomyoma.How to cite this articleKurude VN, Gitte V, Raheja A,et al. Giant Parasitic Fibroid Mimicking Gist: A Clinical Dilemma. J South Asian Feder Menopause Soc 2020;8(1):49–51.

Cluster of “Grapes” in the Pelvis: A Sporadic Case of Disseminated Peritoneal Leiomyomatosis with Endometriosis

A 41-year-old nulliparous woman underwent treatment for infertility using assisted reproductive technology (stimulation cycles for oocyte retrieval and embryo transfers). After 2 biochemical miscarriages, ultrasound and laparoscopy were performed. She reported dysmenorrhea and left pelvic pain. Apart from hypothyroidism, her medical history was unremarkable; there was no history of laparoscopic myomectomy. Initial laparoscopy revealed “bubbles of angry-looking tissue”; results of biopsy reported endometriosis, and cytology of peritoneal washings was negative for malignancy.

2075 A Case of Acute Abdomen Caused by Torsion of Parasitic Leiomyoma

Study Objective The reports of parasitic leiomyoma increase with the spread of the laparoscopic surgery. The origin is considered spontaneous or iatrogenic. In iatrogenic cases, many reports mention that the cause of parasitic leiomyoma is the using morcellator for laparoscopic myomectomy or hysterectomy of leiomyoma. This condition shows various symptoms, and it may develop acute abdomen. We describe the management of this condition and discuss about parasitic leiomyoma together with a review of the literature. Design A case report. Setting A tertiary care hospital. Patients or Participants A 46-year-old, gravida 1, para 1, Japanese woman. Her past history is a laparoscopic myomectomy and excision of endometriosis in several years ago. Interventions Laparoscopic surgery. Measurements and Main Results The patient visited a practicing physician with a chief complaint of acute abdominal pain. Transabdominal ultrasound showed huge pelvic mass, and she referred to our hospital. MRI scan of the pelvic revealed a 15 cm diameter polycystic mass contained with water in the right adnexal region. Since she complained severe pain at the point of the mass, we suspected torsion of ovarian tumor, and we performed emergency laparoscopic surgery. During the procedure, we found the huge mass in the pelvis without connecting to right ovary. The mass was fed by vessels extending from the mesocolon of sigmoid colon and was twisted 1.5 rotations clockwise around the stalk. The mass was resected by the surgeon because GIST was suspected. A histopathological examination showed a leiomyoma. In immune-histological examination, c-kit was negative. Her postoperative course was uneventful. Conclusion It is important to include torsion of parasitic leiomyoma in the differential diagnosis of acute abdomen, especially, for the patients who had medical history of laparoscopic myomectomy.

Десмоидная опухоль передней брюшной стенки у женщины (Клинический случай)

Desmoid tumors (also called desmoids fibromatosis) are rare slow growing benign and musculoaponeurotic tumors. Although these tumors have a propensity to invade surrounding tissues, they are not malignant. These tumors are associated with women of fertile age, especially during and after pregnancy and postoperative surgeries. Our clinical case is interesting because of the rarity of the pathology and the difficulties in setting the correct diagnosis. The patient, with a history of laparoscopic myomectomy (2012), was preparing for a routine surgery for the endometrioma of the anterior abdominal wall, according to the results of the ultrasound and computed tomography. After surgical treatment, the final diagnosis was changed, based on the histological findings. Key words: desmoid tumor, abdominal wall tumor, fibroid.

Successful maternal and perinatal outcomes in a term pregnancy with giant abdominopelvic leiomyomatosis

A 30-year-old second gravida with history of laparoscopic myomectomy and one previous caesarean section was admitted at 31 weeks and 2 days period of gestation (POG) with a diagnosis of...

A Case of Intestinal Obstruction in Pregnancy Diagnosed by MRI and Treated by Intravenous Hyperalimentation.

Intestinal obstruction in pregnancy is rare and is mainly caused by prior pelvic surgery. We herein report a case of intestinal obstruction in a pregnant female with a history of laparoscopic myomectomy, who presented with hypogastric pain, abdominal distension, and vomiting at 26 weeks of gestation. A simple intestinal obstruction was diagnosed by MRI. Conservative treatments, including intravenous hyperalimentation and the placement of an ileus tube, were provided and her abdominal symptoms improved for 14 days. After restarting oral intake, she had no abdominal symptoms. She gave birth to a 2,146 g female infant by caesarean section at 37 weeks and 1 day of gestation. Although an area of cicatrization, which was thought to have been the starting point of the occlusion that caused the intestinal obstruction, was found, the excision of the small intestine was not necessary. Her postoperative course was uneventful. Intestinal obstruction requires a prompt diagnosis and aggressive intervention may be necessary to minimize the morbidity and mortality associated with this rare complication of pregnancy. MRI can be safely used during pregnancy to diagnose intestinal obstruction and intravenous hyperalimentation may improve the maternal and fetal prognoses.

Leiomiomatosis parásita en Medellín, Colombia: reporte de un caso y revisión de la literatura

<p><strong>Objetivo:</strong> mostrar un caso de leiomiomatosis parásita que se presentó después de miomectomía laparoscópica y revisar la literatura disponible respecto a la histopatología, la fisiopatología, el diagnóstico y el tratamiento de la entidad.</p><p><strong>Materiales y métodos:</strong> se presenta el caso de una paciente de 30 años con antecedente de miomectomía por laparoscopia, que consultó a la clínica las Americas (Medellín, Colombia), centro privado de atención, por sangrado uterino de un mes de evolución. Por ultrasonido pélvico se documentó la presencia de leiomiomas uterinos. Fue sometida a nueva laparoscopia que reveló cuatro miomas parásitos en la cavidad pélvica. Se realizó una búsqueda en las bases de datos Medline vía PubMed y SciELO con los términos MeSH: “leiomyomatosis parasitic”, “myomectomy”, “laparoscopic” y “myoma”, y los términos DeCS: “mioma”, “leiomiomatosis parásito” “miomectomía” y “laparoscopia”.</p><p><strong>Resultados: </strong>se seleccionaron 12 artículos de los cuales 10 son reporte de caso, una serie de casos y una revisión narrativa de la literatura.</p>

Extrauterine adenomyoma of the liver with a focally cellular smooth muscle component occurring in a patient with a history of myomectomy: case report and review of the literature

Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1327125766102291.Since first reported in 1986, 14 cases of extrauterine adenomyoma have been reported in the English literature, most often occurring in the ovaries. In this report, we present the first case of extrauterine adenomyoma involving the liver in a 29-year-old woman who presented with a 2-year history of low back pain with recent worsening and a history of laparoscopic myomectomy 5 years previously. Gross inspection of the specimen revealed a subcapsular mass that had a well-circumscribed margin with the adjacent liver tissue. By histopathologic examination, the multilobular mass was composed of a smooth muscle component and benign endometrioid glands and stroma. The smooth muscle component was focally cellular, and the endometrioid glands had secretory features. Both the smooth muscle component and endometrioid tissue were positive for ER and PR. The smooth muscle component was also positive for desmin and SMA, while the endometrioid stroma was positive for CD10. Other extrauterine lesions composed of a mixture of smooth muscle tissue and heterotopic endometrioid tissue, including endometriosis with a smooth muscle component, leiomyomatosis/leiomyomas associated with endometriosis and uterus-like masses, should be included in differential diagnoses. The patient was free from recurrence 5 months after liver tumor resection.

Uterine rupture in a nulliparous woman at 26 weeks' gestation after laparoscopic myomectomy

Uterine scar dehiscence following laparoscopic myomectomy is very rare. We present a case of a nulliparous woman who was pregnant with twins and who had undergone laparoscopic excision of a small subserous myoma 2 years previously. The patient had subsequently developed a uterine rupture at 26 weeks’ gestation; however, this was not initially suspected as the cause of the patient’s abdominal pain owing to the rarity of this event. All pregnant patients who have a history of laparoscopic myomectomy, superficial or deep, should be closely monitored throughout pregnancy and uterine dehiscence or rupture should be suspected if they present with abdominal pain.

Disseminated peritoneal leiomyomatosis arising after laparoscopic myomectomy

Disseminated peritoneal leiomyomatosis is rare condition characterized by multiple subperitoneal nodules of benign smooth muscle proliferations. It is associated with high level of estrogen such as pregnancy, oral contraceptives or estrogen producing ovarian tumor, and occasionally associated with operation history of myomectomy or hysterectomy. Clinical course of disseminated peritoneal leiomyomatosis is usually benign, but malignant changes also rarely have been reported. We experienced a case of disseminated peritoneal leiomyomatosis who has history of laparoscopic myomectomy 10 years ago. The patient was a 35-year-old woman, and her chief complaint was palpable masses in lower abdomen. She underwent laparoscopic surgery which revealed numerous solid masses on the surface of peritoneum, descending colon, rectosigmoid colon, uterus, round ligament, and broad ligament. We present it with a brief review of literature.

Parasitic Myomas: Report of the Largest Case Series

Study Objective: To report the largest case series of parasitic myomas in the medical literature, and an examination of etiologies, associations, and risk factors. Design: Descriptive retrospective study. Setting: Private gynecologic surgery practice at tertiary care center. Patients: 13 patients with the diagnosis of parasitic myoma were identified in a prospective registry of surgical cases performed between August 2000 and April 2008. Intervention: All patients underwent operative laparoscopy. Intraoperative findings were correlated with pathologic findings. Demographic data, previous medical conditions, previous abdominal or pelvic surgery, prior use of morcellation, pathology, postoperative course, and follow up were systematically retrieved from patient medical records. Pathologic confirmation of all specimens was obtained. Measurements and Main Results: Laparoscopic evaluation confirmed the presence of intraperitoneal and retroperitoneal myomas distinct from the uterus in 13 patients. Ten of the 13 patients had prior abdominal surgery. Eight patients had prior morcellation procedures; six performed laparoscopically, two performed by laparotomy. Three patients had multiple parasitic myomas, all of whom had a history of laparoscopic myomectomy with morcellation. The majority (13/17) of myomas were found in the pelvis including two retroperitoneal myomas, and one embedded in the bladder. 8/17 myomas were found along the gastrointestinal tract, and 3/17 were found in the upper abdomen. Conclusion: Parasitic myomas may occur spontaneously as pedunculated subserosal myomas lose their uterine blood supply and parasitize to other organs. However, this series supports what the literature has suggested; more parasitic myomas may be iatrogenically created after prior surgery, particularly surgery using morcellation techniques. With increasing rates of laparoscopic procedures, surgeons should be aware of the potential for iatrogenic parasitic myoma formation, their likely increasing frequency, and intraoperative precautions to minimize occurrence.

Parasitic Myomas

To report a large case series of parasitic myomas and to examine their causes, associations, and risk factors. Retrospective chart review was performed on 12 patients found to have parasitic myomas between August 2000 and April 2008. The following data were systematically collected: surgery date; indications for surgery; number, dates, and types of prior surgeries; prior use of morcellation; and locations of parasitic myomas. Pathologic confirmation of all specimens was obtained. Laparoscopic evaluation confirmed the presence of intraperitoneal and retroperitoneal myomas distinct from the uterus in 12 patients. Ten of the 12 patients had prior abdominal surgery. Eight patients had prior morcellation procedures; six performed laparoscopically, two performed by laparotomy. Three patients had multiple parasitic myomas, all of whom had a history of laparoscopic myomectomy with morcellation. The majority (14 of 15) of myomas were found in the pelvis, including two retroperitoneal myomas, one of which was embedded in the bladder. Six of 15 myomas were found along the gastrointestinal tract, and 1 of 15 was found in the upper abdomen. Parasitic myomas may occur spontaneously as pedunculated subserosal myomas lose their uterine blood supply and parasitize to other organs. More parasitic myomas may be iatrogenically created after surgery, particularly surgery using morcellation techniques. With increasing rates of laparoscopic procedures, surgeons should be aware of the potential for iatrogenic parasitic myoma formation, their likely increasing frequency, and intraoperative precautions to minimize occurrence. III.

Fibromatosis of the appendix and cecum

A tubal ligation was performed on a 33-year-old woman desiring sterilization. During endoscopic inspection of the abdominal cavity, a 5- × 5-cm solid mass was noted on the large intestine (Figure 1). A parasitic myoma was suspected because the patient had a history of laparoscopic myomectomy. The patient subsequently underwent laparoscopic hand-assisted resection of the tumor that was involving the appendix, cecum, and terminal ileum (Figure 2). Final histologic examination revealed that no smooth muscle spindles were present, and a diagnosis of fibromatosis was made.