腹腔鏡下子宮筋腫核出術後に発生したDisseminated peritoneal leiomyomatosisの1例

抄録

  Disseminated peritoneal leiomyomatosis (DPL) is a rare benign disease characterized by tumors derived from smooth muscles throughout the abdominal cavity. Iatrogenic DPL, a recently recognized entity, has been reported following laparoscopic procedures using the morcellation technique due to uterine myomas.

  A 31-year-old woman presented with a palpable mass in the left lower quadrant of the abdomen. Seven years prior, she had undergone laparoscopic myomectomy with power morcellation. Magnetic resonance imaging and computed tomography revealed a subcutaneous mass in the left iliac fossa below a previous laparoscopic trocar site, a uterine myoma, and multiple pelvic masses. After 6 months of administration of gonadotropin-releasing hormone agonists, she was offered laparoscopic tumor reduction surgery. During the laparoscopy, multiple tumors varying in size between 0.5 cm and 6.5 cm were found to be adherent to the upper abdominal wall, retroperitoneal pelvic cavity, and sacral uterine ligament. After laparoscopic resection of all the pelvic lesions, we excised a subcutaneous mass through a skin incision. Histopathological examination of multiple sections of the mass showed features compatible with those of a leiomyoma. Twenty-five months after the surgery, the patient delivered via cesarean section. On follow-up after 55 months, she was asymptomatic, with no clinical evidence of recurrence.

  The frequency of clinical encounters of iatrogenic DPL is considered to increase with an increase in the number of laparoscopic myomectomies and hysterectomies performed. Even for benign conditions, open power morcellation of the uterus may be associated with clinically significant dissemination of the disease. Myoma remnants should be carefully extracted, and confined morcellation should be considered.