title: Surgical removal of multiple mesenteric fibroids (Kg 4,500) by abdominal spread of previous laparoscopic uterine myomectomy.
abstract: BACKGROUND
  Huge and multiple mesenteric fibroids (4,500 Kg weight) are very unusual. In many cases they are mistaken for subserosal fibroids of the womb due to the proximity with uterine walls. When they have a rapid growth, the risk of becoming malignant (sarcoma) has not to be underestimated. Surgery is challenging to remove abdominal nodes.
  
  
  METHODS
  A case of a 40-year old woman, admitted to the hospital with abdominal masses occupying the entire cavity was reported. Both computerized tomography (CT) and ultrasounds (US) were not diriment for belonging of tumours. Clinical history of patient reports a laparoscopic removal of uterine fibroids, using the morcellator. Laparoscopy was performed four years before. Open surgery by means of a large transversal suprapubic laparotomy according to Pfannestiel was carried out. Multiple and huge mesenteric, peritoneal and intestinal tumours spread in the whole abdominal cavity were found, removed and examined by frozen section histology; in addition a series of small conglomerated myomas in the site of previous laparoscopic transumbilical route was taken away as well (the largest fibroid weighed Kg 3.500 and the all tumors removed 4,500 Kg); the result was benign (fibroids) and genital apparatus was preserved. Operation was challenging. Postoperative course was uneventful; after five days patient was discharged.
  
  
  CONCLUSIONS
  This case is very interesting for many factors: A) many extra-uterine fibroids spread throughout abdominal cavity; B) considerable weight of the masses C) intraoperative and postoperative danger. Finally, due to involvement of previous laparoscopic transumbilical incision together with other findings, the hypothesis of post laparoscopic dissemination has to be considered. A case of so large extragenital abdominal fibroids following laparoscopic uterine myomectomy has never been published so far.
authors.forename: V
authors.initials: V
authors.lastname: Leanza
authors.forename: F A
authors.initials: FA
authors.lastname: Gulino
authors.forename: G
authors.initials: G
authors.lastname: Leanza
authors.forename: G
authors.initials: G
authors.lastname: Zarbo
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects*; D007813:Laparotomy; D007889:Leiomyoma / Q000601:surgery; D018231:Leiomyomatosis / Q000209:etiology / Q000601:surgery*; D008643:Mesentery / Q000473:pathology / Q000601:surgery; D009366:Neoplasm Seeding; D010534:Peritoneal Neoplasms / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000009:adverse effects* / Q000379:methods; D014594:Uterine Neoplasms / Q000601:surgery
references.citation: Child Psychiatry Hum Dev. 2014 Oct;45(5):588-95
references.pmid: 24338269
references.citation: Minerva Ginecol. 2009 Jun;61(3):245
references.pmid: 19415068
references.citation: Case Rep Oncol. 2014 May 14;7(2):301-5
references.pmid: 24932171
references.citation: G Chir. 2013 Nov-Dec;34(11-12):323-5
references.pmid: 24342161
references.citation: Minerva Ginecol. 2014 Jun;66(3):299-301
references.pmid: 24971785
references.citation: Psychol Trauma. 2015 Jul;7(4):340-7
references.pmid: 26147519
references.citation: Iran J Med Sci. 2011 Mar;36(1):57-9
references.pmid: 23365481
references.citation: Fertil Steril. 2014 Sep;102(3):630-9
references.pmid: 25171950
references.citation: G Chir. 2014 Jan-Feb;35(1-2):36-41
references.pmid: 24690339
references.citation: J Minim Invasive Gynecol. 2015 May-Jun;22(4):564-72
references.pmid: 25623369
references.citation: Oncol Lett. 2015 Feb;9(2):717-720
references.pmid: 25621042
references.citation: J Child Sex Abus. 2014;23(7):853-60
references.pmid: 25010088
references.citation: G Chir. 2014 Mar-Apr;35(3-4):80-4
references.pmid: 24841685
references.citation: Minerva Ginecol. 2014 Jun;66(3):303-7
references.pmid: 24971786
references.citation: Minerva Ginecol. 2014 Jun;66(3):309-12
references.pmid: 24971787
references.citation: Maturitas. 2015 Mar;80(3):235-6
references.pmid: 25604527