“Iatrogenic” Parasitic Myomas: Unusual Late Complication of Laparoscopic Morcellation Procedures

Abstract 

Study Objective

To describe our experience in diagnosing and managing parasitic myomas developing as an unexpected late complication of laparoscopic morcellation.

Design

Observational study (Canadian Task Force classification II-3).

Setting

University hospital.

Patients

Retrospective chart review of all patients found to have parasitic myomas that developed after previous morcellation.

Intervention

Laparoscopic morcellation. Review of the recent literature correlated with clinical, surgical, and pathologic features of our cases.

Measurements and Main Results

Four patients had heterogeneous pelvic masses after morcellation. In 3 patients, symptoms developed between 2 and 16 years after the primary surgery. One patient had no symptoms, and was referred because of a suspect pelvic mass. Vaginal examination revealed painful pelvic masses in the pouch of Douglas in 2 patients, and painless masses fixed to the vaginal vault and anterior vaginal wall, respectively, in the other 2 patients. Laparoscopic examination confirmed the presence of parasitic masses in 3 patients. In 1 patient, the mass was excised vaginally. Histologic analysis confirmed leiomyoma fragments in all patients. A well-differentiated endometrial carcinoma was incidentally found in 1 patient after hysterectomy.

Conclusion

These masses probably resulted from growth of missed fragments of uterine tissue after previous morcellation, culminating in development of symptomatic iatrogenic parasitic myomas. If morcellation is anticipated or required, exclusion of malignancy is mandatory. Meticulous inspection of the abdominal cavity is necessary after morcellation. In patients with a history of morcellation who have pelvic masses, iatrogenic parasitic myomas should be considered in the differential diagnosis.

Keywords: Laparoscopic morcellation, Retained fragments, Parasitic myoma, Pelvic mass