engleski

Large parasitic myoma arising after laparoscopic myomectomy: a case report

Introduction: The incidence of iatrogenic parasitic myomas associated with the laparoscopic use of electric tissue morcellation is increasing. Morcellation remnants may implant and grow around the peritoneal cavity captivating blood supply from adjacent structure. We report a case of an unusual manifestation of a large parasitic myoma interspersed with endometrial cysts arising six years after laparoscopic myomectomy. Matherials and methods: A 40-year-old nulliparous women underwent laparoscopic myomectomy with electric tissue morcellation for subserous myoma with no intraoperative or postoperative complications. Six years later she presented with large pelvic mass and abdominal discomfort. On physical exam a firm mobile mass about 8 cm in diameter was found in the left pelvis and just above the uterus. Pelvic ultrasound demonstrated a cystic mass (5x2x2.5cm) with ultrasound appearance similar to observed in the case of endometriomas. Results: Laparoscopy was preformed and a large clustered vascularised mass firmly attached to uterine fundus and rectum was found and excised. Cross-section of the tumor revealed multiple cystic cavities filled with altered blood. Hystologically tumor was composed of smooth muscle cells and multiple cavities covered with endometrial stroma and endometrial epithelium. Discussion. All tissue pieces that are morcellated should be diligently removed and irrigated. Implantation and regrowth of morcellated remnants may result with formation of bizarre appearing tumors. Therefore, a parasitic myoma must be included in the differential diagnosis if a solid tumor is found succeeding the use of electric tissue morcellation.

parasitic myoma; electric tissue morcellation

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