Parasitic myomas.
OBJECTIVE
To report a large case series of parasitic myomas and to examine their causes, associations, and risk factors.


METHODS
Retrospective chart review was performed on 12 patients found to have parasitic myomas between August 2000 and April 2008. The following data were systematically collected: surgery date; indications for surgery; number, dates, and types of prior surgeries; prior use of morcellation; and locations of parasitic myomas. Pathologic confirmation of all specimens was obtained.


RESULTS
Laparoscopic evaluation confirmed the presence of intraperitoneal and retroperitoneal myomas distinct from the uterus in 12 patients. Ten of the 12 patients had prior abdominal surgery. Eight patients had prior morcellation procedures; six performed laparoscopically, two performed by laparotomy. Three patients had multiple parasitic myomas, all of whom had a history of laparoscopic myomectomy with morcellation. The majority (14 of 15) of myomas were found in the pelvis, including two retroperitoneal myomas, one of which was embedded in the bladder. Six of 15 myomas were found along the gastrointestinal tract, and 1 of 15 was found in the upper abdomen.


CONCLUSIONS
Parasitic myomas may occur spontaneously as pedunculated subserosal myomas lose their uterine blood supply and parasitize to other organs. More parasitic myomas may be iatrogenically created after surgery, particularly surgery using morcellation techniques. With increasing rates of laparoscopic procedures, surgeons should be aware of the potential for iatrogenic parasitic myoma formation, their likely increasing frequency, and intraoperative precautions to minimize occurrence.


METHODS
III.
Kho
Kimberly A
KA
From the Atlanta Center for Special Minimally Invasive Surgery & Reproductive Medicine, Atlanta, Georgia.
Nezhat
Ceana
C
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D007889:Leiomyoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000601:surgery; D012186:Retroperitoneal Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery
Buttram VC Jr, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 1981;36:433–45.
Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol 1990;94:435–8.
Kelly HA, Cullen TS. Myomata of the uterus. Philadelphia (PA): WB Saunders; 1909. p. 13.
Brody S. Parasitic fibroid. Am J Obstet Gynecol 1953;65:1354–6.
Robbins SL, Cotran RS, Kumar V. Pathologic basis of disease. 3rd ed. Philadelphia (PA): WB Saunders; 1984. p. 1109.
Moon HS, Koo JS, Park SH, Park GS, Choi JG, Kim SG. Parasitic leiomyoma in the abdominal wall after laparoscopic myomectomy. Fertil Steril 2008;90:1201.e1–2.
Sinha R, Hegde A, Mahajan C. Parasitic myoma under the diaphragm. J Minim Invasive Gynecol 2007;14:1.
Takeda A, Mori M, Sakai K, Mitsui T, Nakamura H. Parasitic peritoneal leiomyomatosis diagnosed 6 years after laparoscopic myomectomy with electric tissue morcellation: report of a case and review of the literature. J Minim Invasive Gynecol 2007;14:770–5.
Ostrzenski A. Uterine leiomyoma particle growing in an abdominal-wall incision after laparoscopic retrieval. Obstet Gynecol 1997;89:853–4.
Paul PG, Koshy AK. Multiple peritoneal parasitic myomas after laparoscopic myomectomy and morcellation. Fertil Steril 2006;85:492–3.
Yeh HC, Kaplan M, Deligdisch L. Parasitic and pedunculated leiomyomas: ultrasonographic features. J Ultrasound Med 1999;18:789–94.
Vaquero ME, Magrina JF, Leslie KO. Uterine smooth-muscle tumors with unusual growth patterns. J Minim Invasive Gynecol 2009;16:263–8.
Bekkers RL, Willemsen WN, Schijf CP, Massuger LF, Bulten J, Merkus JM. Leiomyomatosis peritonealis disseminata: does malignant transformation occur? A literature review. Gynecol Oncol 1999;75:158–63.