Parasitic myoma after transabdominal hysterectomy for fibroids: a case report

The patient was a 46-year-old Chinese woman (gravida 1, para 1). One year prior to presentation, she visited our hospital for surgery to remove uterine myomas identified on pelvic ultrasound. Multiple hypoechoic masses in the uterus, the largest of which was approximately 12.9 × 10.4 × 7.6 cm (Fig. 1A, B), and a compressed endometrium were observed on pelvic ultrasound. Therefore, a total transabdominal hysterectomy and bilateral salpingectomy were performed through the transverse incision of a previous cesarean section.

During the operation, multiple myomas were observed in the uterus, the largest of which (12 × 10 cm) was located in the right anterior wall (Fig. 1C). The operation was uneventful, and there was no evidence of myomas in any extrauterine location at the time of surgery. Paraffin-embedded pathology revealed multiple uterine leiomyomas. Microscopic examination revealed spindle-shaped tumor cells arranged in a braided pattern (Fig. 1D). No abnormalities were found in the outpatient review at 1 month postoperatively.

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Twenty days ago, the patient revisited our department with a 4 cm palpable mass in the right lower quadrant of the abdomen. Pelvic ultrasound revealed a 4.3 × 3.8 × 3.5 cm mass in the right iliac fossa with a clear boundary and heterogeneous medium and low echo (Fig. 2A, B). Color Doppler flow imaging revealed blood flow signals (Fig. 2C). Abdominal computed tomography (CT) revealed an oval, soft tissue density mass in the right iliac fossa. The CT value was approximately 53 Hounsfield units, the boundary was clear, and the size was 4.6 × 3.1 cm (Fig. 2D). The serum carbohydrate antigen-125 level was normal. A broad ligament myoma or solid ovarian tumor was considered before surgery, and laparoscopic exploration was performed under general anesthesia.

During the operation, a tumor measuring approximately 4.5 × 4.0 cm could be seen in the right anterior abdominal wall, which is located approximately 3 cm from the right edge of the previous transverse incision. The color was pinkish white and the surface was smooth (Fig. 3A, B, C); a parasitic myoma was considered. The uterus and bilateral fallopian tubes were absent and both ovaries were normal. The peritoneum on the surface of the tumor was incised using a monopolar electric hook, and the tumor was completely resected. The tumor was placed in a retrieval bag and removed from the abdominal cavity. Specimens were sent for frozen pathology analysis; the results were benign. Paraffin-embedded pathological results suggested leiomyoma. Microscopic examination revealed spindle-shaped tumor cells arranged in a braided pattern (Fig. 3D). The patient recovered well and was discharged on postoperative day 3. No abnormalities were found during the outpatient follow-up at 1 month postoperatively.

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