子宮筋腫の診断で腹腔鏡下子宮全摘術を施行し術後１年で多発腹腔内腫瘤を認め、子宮肉腫の診断に至った１例

抄録

　The adoption of laparoscopic surgery for managing uterine fibroids has significantly increased in recent years. However, iatrogenic ectopic uterine fibroids may occur in up to 1% of cases following laparoscopic tumor shredding with a morcellator. Here, we report the case of a patient who underwent a laparoscopic total hysterectomy with tumor shredding performed without in-bag containment. Ten months post-surgery, the patient began experiencing abdominal pain. Ultrasonography and MRI revealed multiple intraperitoneal tumors. GnRHa hormone therapy was administered to reduce estrogen levels, and a reoperation was performed to establish a definitive diagnosis. Pathological examination confirmed uterine sarcoma stage IIIb. The patient underwent chemotherapy and continued treatment for 35 months following surgery. This case highlights the risks associated with tumor shredding during laparoscopic total hysterectomy and myomectomy. Intraperitoneal scattering poses a significant risk, particularly in cases of parasitic myoma or undiagnosed malignant tumors. We recommend considering in-bag shredding techniques whenever feasible to minimize the potential for tumor dissemination and improve patient outcomes.