Iatrogenic Parasitic Myoma with Two Recurrence Times after Subsequent Myomectomy: A Rare and Complicated Case Report

Abstract

Increasing number of parasitic myoma (PM) cases due to specimen morcellation during minimally invasive surgery have been reported. The patient was a 46-year-old woman receiving laparoscopic subtotal hysterectomy due to fibroids. She was diagnosed as having PM and had two recurrences after subsequent myomectomies. To prevent recurrence, specimen-contained morcellation was performed during the myomectomies and postoperative ulipristal acetate was given, but with no effects. The interval between each recurrence decreased. Progressive lower abdominal pain and prominent vessels on the myoma were the two distinct clinical characteristics that differentiated PM from general myoma. This case study highlights the importance of specimen containment before morcellation in minimally invasive surgery and implies that the pathogenesis of PM recurrence is unknown.

Keywords: Parasitic myoma; power morcellator; specimen removal.

Figure 1

(a) During the initial laparoscopic subtotal hysterectomy, an enlarged uterine (U) with two globular and protruding myomas (M1, M2) were found at the anterior and posterior walls. (b) Computed tomography shows multiple heterogeneous enhanced solid tumors in the pelvic abdomen, with size ranging from 2.5 to 10 cm, located near the right side of the bladder (parasitic myoma 1), on the sigmoid colon (parasitic myoma 2), and the right common iliac artery (parasitic myomas 3) (yellow arrows). (c) Repeat laparoscopic surgery revealed parasitic myoma. The 5.0 cm × 4.5 cm mass (parasitic myoma 1) arises from the right bladder just adjacent to the right ureter and the 10.0 cm × 9.5 cm (parasitic myoma 2) mass arises from the pelvis and is densely adhered to the sigmoid colon. (d) Another 5.0 × 4.0 cm mass (parasitic myoma 3) is present on the peritoneum at the right common iliac artery