Progression of Pelvic Implants to Complex Atypical Endometrial Hyperplasia After Uterine Morcellation

Abstract

Histology found during reoperation after laparoscopic supracervical hysterectomy includes endometriosis, residual endometrium, and leiomyomas. In this case, a woman with no prior history of endometrial atypia later developed complex adenomatous endometrial hyperplasia in a peritoneal implant. This finding adds to the list of possible complications after laparoscopic-assisted supracervical hysterectomy and uterine morcellation.

Parasitic leiomyomas: a systematic review

“…The authors do not report conflict of interest Abdel-Gadir, 2010 75 Al Manasra, 2011 59 Al Talib, 2010 9 Al Talib, 2010 9 Atkin, 2010 110 Aust, 2011 58 Berhan, 2003 56 Boqusiewicz, 2013 65 Brieger, 1995 40 Brody, 1953 93 Chan, 2004 12 Chu, 2012 86 Cucinella, 2011 36 Dan, 2012 52 Donnez, 2007 38 Elagwany, 2014 92 Epstein, 2009 94 Florez-Peña, 2012 87 Ghamande, 1996 57 Giannelli, 2013 83 Gómez, 2014 106 Goppel, 2009 68 Green, 2011 95 Hartzell, 2014 39 Hayashi, 2015 44 Heinig, 2003 24 Heuer, 2013 66 Hilger, 2006 23 Hirayama, 2015 42 Holloran, 2015 51 Huang, 2014 19 Hwang, 2010 60 Jebunnaher, 2013 73 Kamaci, 2004 118 Kang, 2009 76 Karadza, 2013 46 Kawasaki,2013 43 Kebapci, 2002 55 Keogh, 2003 84 Kill, 2011 48 Kho, 2009 3 Knudsen, 2006 49 Kumar, 2008 63 LaCoursiere,2005 116 Larrain, 2010 136 Lee, 2012 …”

“…Sometimes parasitic leiomyomas are associated with other benign conditions such as endometrial cysts 46 or endometriosis 47 and can even undergo atypical transformation 48,49 .…”

Laparoscopic Subtotal Hysterectomy: Evidence and Techniques

“…Evidence from case reports suggests that iatrogenic endometriosis may complicate hysterectomy with associated uterine morcellation. In patients in whom no endometriosis was observed at hysterectomy, postoperative pain requiring further surgical exploration demonstrated endometriosis [91][92][93], and even peritoneal endometrial hyperplasia has been described [94]. These findings may be explained by the implantation and proliferation of residual endometrium left in situ after uterine morcellation [95].…”

Place de l’hystérectomie supracervicale et de l’abord cœlioscopique pour fibromes symptomatiques

“…Par ailleurs, avant d'envisager une hystérectomie subtotale par coelioscopie, il est indispensable de réaliser au préalable une biopsie de l'endomètre dans le cadre d'une hystéroscopie diagnostique afin d'éliminer une pathologie endométriale sous-jacente du fait d'un risque de dissémi-nation intrapéritonéale lors de la morcellation utérine [49].…”