title: Iatrogenic parasitic leiomyoma and leiomyomatosis peritonealis disseminata following uterine morcellation.
abstract: OBJECTIVE
  To assess the impact of morcellation on the spread of uterine leiomyoma.
  
  
  METHODS
  Cases of parasitic leiomyoma involving prior laparoscopy were collected between 2012 and 2015 in a tertiary women's hospital in China. Their clinicopathological features and the associated reports were reviewed.
  
  
  RESULTS
  All six patients with parasitic leiomyoma had laparoscopic myomectomy or hysterectomy with power morcellation 39-132 months previously. Patient 1 had widely disseminated tumors in the peritoneum and pelvis, in keeping with leiomyomatosis peritonealis disseminata (LPD). She received debulking of peritoneal tumors and lived with disease for 22 months. The implanting sites of the other parasitic tumors (patients 2-6) included the mesentery (n = 2), intestine (n = 1), pelvic parietal (n = 1), bladder (n = 1), and musculus rectus abdominis (n = 1). The diameter varied from 1 cm to 6 cm. The patients underwent abdominal subtotal hysterectomy, cervicectomy or tumor debulking and the postoperative course was unremarkable for a period of 2-32 months. Pathologically, these disseminated or parasitic leiomyomas did not show any evidence of malignancy. There were no morphological or immunohistochemical differences between the original tumor and the following seeding tumors. On literature review, 11 iatrogenic LPD have been reported after laparoscopic surgery for uterine leiomyoma. These cases may provide an alternative pathogenic mechanism for a distinct variant of LPD.
  
  
  CONCLUSIONS
  Laparoscopic hysterectomy with tumor morcellation may increase the chance of tumor implantation and dissemination. Both clinicians and pathologists should be alert to this rare complication.
authors.affiliation: Department of Surgical Pathology, Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Bingjian
authors.initials: B
authors.lastname: Lu
authors.affiliation: Department of Surgical Pathology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
authors.affiliation: Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Zimin
authors.initials: Z
authors.lastname: Pan
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007049:Iatrogenic Disease; D010535:Laparoscopy / Q000009:adverse effects; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D018231:Leiomyomatosis / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D000069577:Morcellation / Q000009:adverse effects* / Q000379:methods; D009366:Neoplasm Seeding; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000009:adverse effects* / Q000379:methods; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: leiomyomatosis peritonealis disseminata; morcellation; parasitic leiomyoma; seeding tumor