Uterine leiomyomas are the most common benign pelvic tumours in women, occurring in at least 25% of reproductive aged women and up to 80% on pathologic examination of surgically removed uteri.[1] Parasitic leiomyomas, first described in 1909, are a rare type of extra-uterine fibroid which are thought to arise from a subserosal fibroid which obtains a blood supply from other structures with resultant deterioration of its uterine pedicle. The rise of laparoscopic surgery and power morcellation has seen an increasing incidence of the iatrogenic parasitic fibroid[2]. The FDA has put a warning on the use of power morcellation[3] due to the risk of disseminating a uterine sarcoma, which has resulted in a drastic decline in the use of power morcellation and the entry of “morcellation bags” into the market.
This video demonstrates the case of a 40 year old para 2 patient presenting with a rapidly growing 11cm fibroid 8 years after a laparoscopic myomectomy with power morcellation for treatment of menorrhagia. Intra operative findings demonstrated a parasitic fibroid with a single source of vascular supply arising from Right Infudibulopelvic ligament. The fibroid was excised by ligation of the pedicle and in bag power morcellation.
[1] Payson M, Leppert P, Segars J. Epidemiology of myomas. Obstet Gynecol Clin North Am 2006;33:1–11
[2] Lete I., Parasitic leiomyomas: a systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 203 (2016) 250-259.
[3] Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication. April 2014