Leiomioma parasitario retroperitoneal: reporte de un caso / Retroperitoneal parasitic leiomioma: A case report

Resumen ANTECEDENTES: Los leiomiomas parasitarios son una variante poco común de la miomatosis uterina. Se han identificado en la pared abdominal, intestino delgado, muñón cervical o vaginal, vasos iliacos, ovarios, colon sigmoides y en el omento mayor. OBJETIVO: Reportar un caso clínico de leiomioma parasitario retroperitoneal y revisar la bibliografía al respecto. CASO CLÍNICO: Paciente de 57 años, con diagnóstico de NIC-III y hemorragia uterina anormal. Acudió a consulta debido a una sensación de masa y dolor abdominal, pérdida de peso subjetiva, hiporexia, disfagia y plenitud gástrica de cuatro meses de evolución. En los estudios de extensión se documentó una masa retroperitoneal grande y elevación de los marcadores tumorales Ca 125 y Ca 19-9. La resección de la masa se efectuó mediante laparotomía, con hallazgo histopatológico de mioma parasitario. CONCLUSIÓN: Los leiomiomas parasitarios deben considerarse en el diagnóstico diferencial de pacientes con antecedente de histerectomía o miomectomía, sobre todo en el contexto de la morcelación. El tratamiento consiste en cirugía o inhibidores de la aromatasa y análogos de la hormona liberadora de gonadotropina (leiomiomatosis peritoneal diseminada).

Abstract BACKGORUND: Parasitic leiomyomas are a rare entity, defined as an unusual variant of uterine myomatosis. Have been documented in the abdominal wall, small intestine, cervical or vaginal stump, iliac vessels, ovaries, sigmoid colon, and greater omentum. OBJECTIVE: To report a clinical case of retroperitoneal parasitic leiomyoma and review the literature. CLINICAL CASE: A 57-year-old patient with a diagnosis of CIN-III and secondary abnormal uterine bleeding, who consulted for a sensation of abdominal mass and pain, subjective weight loss, hyporexia, dysphagia and gastric fullness, of four months of evolution. Extension studies document a large retroperitoneal mass and elevation of tumor markers Ca 125 and Ca 19-9. We practice surgical management of her gynecological pathology and resection of the mass by laparotomy, with histopathological finding of myoma. CONCLUSION: Parasitic leiomyomas should be suspected in patients with a detected mass and a history of hysterectomy or myomectomy, especially in the context of morcellation. The treatment of this condition is surgical and, in cases of disseminated peritoneal leiomyomatosis, pharmacological treatments have been used with aromatase inhibitors and gonadotropin-release hormone analogues.

Myomectomy for uterine preservation and fertility

Background: Leiomyomas are benign monoclonal smooth muscle tumors that are characterized by cellular mutations, growth factor dysfunction, and abnormalities in the extracellular matrix. The objective of this study was to analyse the patient selection, feasibility, complications and the outcomes of myomectomies done for uterine preservation and fertility.Methods: Out of 606 myomectomies performed over 23 years at a tertiary care endoscopy centre, retrospective analysis of 358 cases of laparoscopic myomectomy (LM) and 96 cases of abdominal myomectomy (AM) was done.Results: Myomectomies were done for symptomatic women who wanted to preserve their uterus either to improve fertility or pregnancy outcome. Sizes of myomas tackled by myomectomy ranged from 1 cm to 20 cms. The largest number removed by laparoscopy was 19. 9 out of 358 cases scheduled for LM were converted to AM. 6 patients had repeat myomectomy of myomas. About 0.44% had STUMP and 0.44% had leiomyosarcoma on HPE. Only 10/199 or 5% of patients who wanted to preserve their uterus had subsequent hysterectomies. 95% were satisfied with good symptom relief. 40.1% in LM and 37% in AM group conceived.Conclusions: Majority of the cases were successfully done by laparoscopy. With increasing experience more cases with bigger and multiple myomas could be tackled by laparoscopy. 10.3% in LM and 45.9% in AM were 10 cms-20 cms. The main method of retrieval was morcellation. There were no major complications. Both the methods were found to be safe, feasible and provided good result. With increasing experience bigger and multiple myomas could be tacked by LM, which has several advantages over AM.

Disseminated peritoneal leiomyomatosis: a devastating sequelae of unconfined laparoscopic morcellation

There has been growing concern surrounding the use of unconfined power morcellation in laparoscopic surgeries for uterine leiomyoma due to its associated risks and long-term clinical sequelae, including parasitic leiomyomas and disseminated peritoneal leiomyomatosis (DPL). We present a case of DPL resulting from previous laparoscopic morcellation and a review of the existing literature. DPL is a potentially devastating consequence of unconfined laparoscopic morcellation in the surgical management of uterine fibroids. A multidisciplinary approach is recommended in the management of DPL, especially in cases of multivisceral involvement. Clinical caution ought to be exercised when using power morcellators; when unavoidable, confined laparoscopic morcellation offers a promising mitigation and should be adopted if practicable.