Parasitic Leiomyoma at Laparoscopic Trocar Site: A Report of 2 Cases

Abstract

BACKGROUND Parasitic leiomyoma refers to leiomyomas outside the uterus, with a prevalence of 0.07%. Patients are initially asymptomatic and may later develop abdominal pain and abdominal distension. Parasitic leiomyomas at a trocar site are extremely rare and lack detailed reporting. Here, we report 2 cases of parasitic leiomyoma at trocar sites. CASE REPORT Case 1. The patient was a 47-year-old woman with parasitic leiomyomas at a left trocar site 4 years after laparoscopic total hysterectomy. After being diagnosed with 3 masses on the surface of the sigmoid colon and 2 in the pelvic cavity, the patient underwent laparoscopic removal of a pelvic lesion and 3 lesions on the surface of the colon, combined with excision of abdominal wall masses. The pathology result indicated that the masses at the left trocar site were multiple leiomyomas, the intestinal mass was multiple leiomyomas with abundant cells, and the pelvic mass was fibrous capsule parietal tissue. This patient received 3 months of gonadotropin-releasing hormone agonist (GnRH-a) treatment, and was followed up for 9 months without recurrence. Case 2. The patient was a 50-year-old woman with parasitic leiomyoma at the right trocar site 15 years after laparoscopic removal of the right ovarian cyst. At admission, she underwent transabdominal total hysterectomy, bilateral fallopian tube resection, and abdominal wall lesion resection. The pathology report showed multiple leiomyomas of the uterus, and the cell-rich parasitic leiomyoma at right trocar site with unclear boundary. She received 3 months of GnRH-a treatment, and was followed up for 6 months without recurrence. CONCLUSIONS For patients with a history of laparoscopy, gynecologists should be alert to the occurrence of parasitic leiomyoma.

Figure 1.

B-ultrasound of case 1. The results displayed 2 uneven low echoes in the pelvic cavity, with sizes of approximately 5.2×5.1×3.7 cm (A) and 2.5×2.0×2.4 cm (B), respectively (the red arrow indicates the location of the low echo).

Figure 2.

The picture of myomatous nodules of case 1. Photos of abdominal myomatous nodules of case 1 in the operating room (A) (the cranial end is on the right side of the image). The other abdominal myomatous nodules were found at the left trocar site during laparoscopy (B), and 3 myomatous nodules were found near the rectum in the lower part of the sigmoid colon (C, D).

Figure 3.

B-ultrasound of abdominal masses in case 2. The results showed there were multiple hypoechogenic masses in the right lower abdominal muscle layer, and the larger 2 were 4.6×1.3×3.2 cm (A) and 4.4×2.4×1.6 cm (B), with irregular shape. These masses were lobulated and had abundant blood flow signals (the red arrow indicates the location of hypoechogenic masses).

Figure 4.

B-ultrasound of uterus in case 2. The results showed that 1.7×1.6×1.4 cm of uneven echo in the uterine cavity, and the birth control ring in the uterine cavity (A) (the red arrow indicates the location of uneven echo). There were multiple hypoechogenic masses in the uterine area, the largest of which was 6.3×5.7×4.6 cm in the anterior wall of the uterus, and capsular blood flow is seen (B) (the red arrow indicated the location of hypoechogenic masses). Bilateral ovaries were indistinguishable.

Figure 5.

Photos of abdominal myomatous nodules of case 2 in the operating room (the cranial end is on the bottom of the image).

Figure 6.

The picture of case 2, including uterus, which has multiple leiomyomas (A), and parasitic leiomyoma at right trocar site (B).