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).

ABSTRACT

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.

Download (PDF, Unknown)

The post Peritoneal Enclosure of Embolization Particles Mimicking Peritoneal Carcinomatosis first appeared on CRSLS.

Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan (all authors).

ABSTRACT

Introduction: Parasitic myoma after laparoscopic myomectomy with power morcellation is an emerging concern that has an iatrogenic aspect. However, the duration necessary for observation to identify parasitic myoma has not yet been clarified.

Case Description: A 47-year-old, gravida 2, para 2 woman was referred for an unusual pelvic mass. Her gynecological history was significant, with laparoscopic myomectomy with power morcellation for intraligamental myoma 14 years earlier. Uterine myoma, endometrial polyp, and suspicious parasitic myomas were diagnosed by magnetic resonance imaging. In a laparoscopic view, 4 parasitic myomas were identified. Single-port laparoscopic-assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and debulking of the parasitic myomas were performed. Histopathological examination demonstrated that the parasitic myomas were histologically similar to the myomas excised 14 years earlier.

Conclusion: Women who have already undergone myoma surgery with power morcellation should be followed up carefully for the potential development of parasitic myoma.

Key Words: Laparoscopic myomectomy, Magnetic resonance imaging, Parasitic myoma, Power morcellation.

Download (PDF, Unknown)

The post Parasitic Myoma Identified 14 Years After Laparoscopic Myomectomy first appeared on CRSLS.