Elsevier

Journal of Minimally Invasive Gynecology

Volume 17, Issue 5, September–October 2010, Pages 544-550
Journal of Minimally Invasive Gynecology

Review Article
Iatrogenic Myomas: New Class of Myomas?

https://doi.org/10.1016/j.jmig.2010.04.004Get rights and content

Abstract

Parasitic myomas, defined as extrauterine seeding of leiomyoma, have been reported since the early 1900s. These myomas were thought to be spontaneously occuring, separate from the uterus but still hormone-dependent and can cause symptoms. What seemed to be a rare disorder developing from the natural history of pedunculated myomas has become increasingly reported over the last decade. Because it is still a rare disorder, the literature is limited to case reports. Herein, we review the literature and provide an analytic review of recent case reports, with emphasis on etiology, trends, and risk factors, to increase awareness of this problematic entity.

Section snippets

Are We Witnessing a Trend?

Described by Kelly and Cullen [3] in 1909 as “myomata that have for some reason become partially or almost completely separated from the uterus and receive their main blood supply from another source,” parasitic myomas attracted some attention in the early 1900s and were written about in the literature of that time [4]. One report in 1953 described a similar entity of a 6-cm myoma attached to the omentum [4], and in the 1990s, there were 2 reports of acute abdomen with suspected ovarian torsion

Spontaneous Parasitic Myomas

In their 1909 text, Myomata of the Uterus, Kelly and Cullen [3] include a chapter on parasitic myomas and report a series of 37 parasitic myomas. They subscribe the cause of such myomas as “inherent in the myomata and not in the surrounding organs,” and surmise that the uterus, as it tries to “naturally get rid of its interstitial nodules,” contracts until a submucous myoma becomes pedunculated, and finally the mass of the myoma creates such traction on its pedicle that it becomes separated

Literature Review of Parasitic Myoma Case Reports

Relevant English-language sources were identified in a search of PUBMED and MEDLINE databases from January 1950 to October 2009 using the key words “Iatrogenic,” “Leiomyoma,” “Myoma,” “Neoplasm,” “Parasitic,” and “Seeding.” Fourteen separate case reports and 1 case series of parasitic myomas were found in the literature 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 (Table 1). The earliest report was in 1953 by Brody [4], and the most recent was published in 2009 by us [7]. There has been

Parasitic Myomas after Surgery

While most cases reported are associated with laparoscopic myomectomy, some cases have occurred with supracervical hysterectomy, total laparoscopic hysterectomy, and vaginal hysterectomy 9, 13, 18. Unless a colpotomy is performed, both laparoscopic myomectomy and supracervical hysterectomy usually require abdominal morcellation to remove the specimens. Although “lost” fragments associated with laparoscopic resections were reported as early as 1997, including 3 myomas lost in the abdominal

Nonsurgical “Iatrogenic” Parasitic Myomas?

In a pathophysiologic process such as that described by Kelly and Cullen [3], in theory, parasitic myomas may be formed by any process that restricts blood supply to the uterus. Therapeutic administration of gonadotropin-releasing hormone agonists has become increasingly popular as a temporizing method to diminish uterine volume. Restriction of blood supply is intended to occur and, thus, treat the symptoms of a myomatous uterus. Analogously, other minimally invasive procedures such as uterine

Iatrogenic Nodules

Not unrelated, leiomyomatosis peritonealis disseminata (LPD) is a rare, typically benign condition characterized by multiple peritoneal smooth-muscle, myofibroblastic, and fibroblastic nodules on the peritoneal surfaces of the pelvic and abdominal cavities [22], often studding the surface of the uterus, intestines, and abdominal walls. The condition typically develops in women of reproductive age. Theories for the pathogenesis of LPD include metaplasia of pluripotent mesenchymal stems cells,

Discussion

Although still rare relative to the ubiquity of leiomyomas, we believe that a review of the recent literature reveals substantial potential for development of a new class of myomas, that is, iatrogenically formed myomas. While the establishment of causality requires more robust evidence than simple correlation, the totality of the case reports and case series describing parasitic myomas as well as LPD begin to illustrate something more than a trend, and the criteria of Hill [26] for the

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The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

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