Kai Kentaro, Aoyagi Yoko, Nishida Masakazu, Arakane Motoki, Kawano Yasushi, Narahara Hisashi
Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan.
Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan.
SAGE Open Med Case Rep. 2020 Sep 18;8:2050313X20959223. doi: 10.1177/2050313X20959223. eCollection 2020.
Although parasitic leiomyoma could be spontaneous or iatrogenic in origin, port-site implantation of parasitic leiomyoma is an iatrogenic benign sequela of laparoscopic surgery. A 30-year-old, primigravida Japanese woman was referred after unresponsiveness to preoperative gonadotropin-releasing hormone for intramural fibroids. Magnetic resonance imaging showed multiple intramural fibroids and left ovarian endometrioma with no malignant features. Laparoscopic myomectomy with power morcellation and ovarian cystectomy were performed, followed by treatment with a combined oral contraceptive. Seven years after the primary surgery, she underwent abdominal myomectomy for a port-site, and peritoneal recurrence of the leiomyoma and intramural leiomyomas was detected. Microscopic examination revealed that resected specimens from the port-site demonstrated leiomyoma with lesser cell density and more prominent hyalinization than those from the uterus. Therefore, clinicians should counsel patients regarding the risks and benefits of laparoscopy with morcellation versus laparotomy. Further development of techniques for uterine tissues extraction is warranted.
尽管寄生性平滑肌瘤的起源可能是自发的或医源性的，但寄生性平滑肌瘤的穿刺孔植入是腹腔镜手术的一种医源性良性后遗症。一名30岁的初产妇日本女性因术前使用促性腺激素释放激素治疗壁间肌瘤无效而前来就诊。磁共振成像显示多个壁间肌瘤和左侧卵巢子宫内膜瘤，无恶性特征。进行了腹腔镜子宫肌瘤切除术和电动粉碎术以及卵巢囊肿切除术，随后使用复方口服避孕药进行治疗。初次手术后七年，她因穿刺孔处的肌瘤接受了腹部子宫肌瘤切除术，并检测到平滑肌瘤和壁间肌瘤的腹膜复发。显微镜检查显示，穿刺孔处切除的标本显示平滑肌瘤的细胞密度低于子宫标本，玻璃样变更明显。因此，临床医生应就腹腔镜粉碎术与开腹手术的风险和益处向患者提供咨询。子宫组织提取技术的进一步发展是必要的。
