Giovanni Favero, MD, Christhardt Kohler, MD, Anna Jacob, MD, Tatiana Pfiffer, MD, Andrea Molgg, MD
Department of Gynecology, Helios Mariahilf Hospital Hamburg, Germany (Dr Favero).
Department of Advanced Operative and Oncologic Gynecology, Asklepios Hospital, Hamburg Altona, Germany and University of Cologne, Medical Faculty, Department of Gynecology (Dr Kohler).
Department of Advanced Operative and Oncologic Gynecology, Asklepios Hospital, Hamburg Altona, Germany (Drs Jacob and Molgg).
Department of Gynecology, Helios Mariahilf Hospital Hamburg, Germany (Dr Pfiffer).
Introduction: This case report demonstrates a rare complication that can be associated with power morcellation at the time of laparoscopic fibroid removal (myomectomy) in a patient previously treated by uterine artery embolization (UAE) that led to a relevant clinical misdiagnosis. UAE is an approved treatment option for symptomatic uterine fibroids. However, very little is known about possible migration of embolization particles into non-target organs.
Case Description: A 47-year-old woman was previously submitted to bilatera UAE due to large, symptomatic fibroids. Despite initial proven regression, she underwent endoscopic myomectomy one year later with unprotected morcellation. Approximately five years after endoscopic surgery a suspicious pelvic tumor with radiological signs of peritoneal carcinomatosis was found. The patient underwent total laparoscopic hysterectomy along with complete resection of the pelvic parietal peritoneum, where multiple peritoneal abnormalities were found. Intraoperative frozen section revealed inclusions of embolization particles within peritoneal leasions. Final pathology confirmed a uterine STUMP (smooth muscle tumor with uncertain malignant potential), a chronic inflammatory reaction of the peritoneum and the presence of multiple microspheres.
Conclusion: The current report is the first to describe the presence of embolization particles in the peritoneum, mimicking peritoneal carcinomatosis.
Key Words: Uterine artery embolization, Tris-acryl gelatin microspheres, Laparoscopic myomectomy, Power morcellation, Peritoneal carcinomatosis.