Disseminated Peritoneal Leiomyomatosis Status Post Laparoscopic Hysterectomy with Morcellation

摘要

Uterine leiomyomas (fibroids) are common benign neoplasms, which develop from the muscular tissue of the uterus with an estimated incidence of 20–40% in women of reproductive age. In the early nineties, power morcellators were introduced and became commonly used during hysterectomy for symptomatic fibroids. However, if all fragments are not removed, they may parasitize to other blood supply and present as abdominal or pelvic masses. Unfortunate cases have also been reported in which uterine sarcomas seeded throughout the abdomen and pelvis secondary to morcellation. The Food and Drug Administration (FDA) estimates that 1 in 350 women undergoing hysterectomy or myomectomy for fibroids is found to have an unsuspected uterine sarcoma. As a result, the FDA issued a press release in 2014 discouraging the use of power morcellators. Recently, the FDA approved a new containment device, the PneumoLiner, for use with certain power morcellation devices. However, it is unknown if this device will help to reduce the risk of seeding fibroids and unsuspected uterine malignancies. We present a case in which a patient who underwent morcellation therapy for symptomatic fibroids presented with recurrent abdominal and pelvic leiomyomas mimicking malignancy. Keywords: Fibroids, morcellator, seeding, implants, pelvis, uterus, recurrent fibroids, morcellation, Computed Tomography, Ultrasound, leiomyomaCASE REPORTA 50-year-old female with a past medical history of uterine fibroids status post robotic hysterectomy with morcellation presented with acute abdominal pain. She had a noteworthy family history of uterine leiomyosarcoma and lymphoma.The patient was initially diagnosed with multiple uterine fibroids via ultrasound in December 2010 [Figure 1], the largest of which was posteriorly located and measured 6.7 × 5.8 × 4.9 cm. Conservative management and routine follow up was planned. The patient returned for follow up ultrasound in June 2011 [Figure 2], which demonstrated interval enlargement of the fibroids now measuring up to 8.3 cm in greatest dimension. A robotic approach was not being offered at that time at this institution. Therefore, she sought evaluation at an outside institution where she ultimately underwent a robotic hysterectomy with a power morcellator. Open in a separate windowFigure 1 50 year old female patient: Diagnosis of Disseminated Peritoneal Leiomyomatosis Status Post Laparoscopic Hysterectomy with Morcellation.Findings: Transabdominal ultrasound of the uterus in the sagittal plane at original presentation for pelvic pain, demonstrates a posteriorly located fibroid [cursors] measuring up to 6.7 cm.Technique: B-mode Transabdominal sonogram of the pelvis. Sagittal section of the uterus. Ultrasonography was performed using 3–5MHz curvilinear transducer.