Post-morcellation Parasitic Fibroids: A Case Report

Nagendra P Nagothi, Mehendi K Javali
2019 The Journal of Medical Sciences  
Uterine fibroids are histologically benign tumors that originate from smooth muscle cells and usually seen in the genitourinary tract such as in the vulva, ovaries, urethra, and urinary bladder but may arise in nearly any anatomic site. Leiomyomas that become adherent to surrounding structures (e.g., the broad ligament, omentum, or retroperitoneal connective tissue) develop an auxiliary blood supply and lose their original attachment to the uterus, thus becoming "parasitic. " These lesions may
more » ... anifest as extrauterine pelvic masses that compress the urethra, bladder neck, or ureter and may produce symptoms of varying degrees of urinary outflow obstruction or secondary hydroureteronephrosis. We herewith report the relationship of power morcellation and the development of parasitic fibroids in two patients after laparoscopic hysterectomy. Case description: Case 1: A 30-year-old patient presented to the hospital with an abdominal mass that was progressively increasing over a 2-year period. The histology of the mass showed interlacing bundles of benign smooth muscle fibers consistent with a leiomyoma. Surgical excision of the mass was done. Case 2: A patient of 41 years nulligravida presented to the hospital with complaints of pain in the abdomen, continuous dull aching type of pain that relieved on medication for 2 months, and a palpable mass per abdomen since 1 month. Ultrasound findings showed a large mass in pelvis posterior to uterus, likely indicating parametrial fibroid or ovarian fibroid. Total laparoscopic hysterectomy with open myomectomy treatment was done for the patient. Conclusion: Parasitic leiomyomas are caused following laparoscopic myomectomy or hysterectomy. Given the potential sequelae of retained fragments, careful attention to remove all residual specimens is warranted, and morcellation should be done in a containment bag.
doi:10.5005/jp-journals-10045-00136 fatcat:vbfshuguuvgevhliw64fdqx62u