Port site parasitic leiomyoma after laparoscopic myomectomy: a case report and review of the literature

BACKGROUND: Uterine fibroids are the commonest benign gynecological tumors. Laparoscopic myomectomy is becoming increasingly popular as one of the surgical treatment options for symptomatic cases. Large tissues such as leiomyomas or even the uterus need to be morcellated in order to be retrieved from the abdominal cavity. Some of the morcellated fragments or small fibroids may be accidentally left in the abdominal cavity during the retrieval process. These may subsequently become implanted in the abdominal cavity, develop blood supply from the surrounding structures, and grow to form parasitic myomas with varied clinical presentation, depending on the location and size. CASE PRESENTATION: A 47-year-old African woman presented to our hospital 6 years after laparoscopic myomectomy with a lower abdominal mass. Her work-up revealed an anterior abdominal wall mass consistent with uterine leiomyoma. She was scheduled for excision of the mass, which was subsequently histologically confirmed to be a uterine fibroid. CONCLUSIONS: Parasitic leiomyomas are a rare late complication of power morcellation following laparoscopic myomectomy or hysterectomy. Most patients present with an abdominal/pelvic mass and may need surgical excision to relieve the symptoms. Care should be taken during power morcellation to prevent excessive fragmentation of the tissues, some of which may become implanted and persist to form parasitic myomas. Moreover, effort should be made to retrieve all myoma fragments by carefully checking the abdominal cavity. Whenever possible, the morcellation should be done in a containment bag.