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DOI: 10.1055/s-0030-1250509
© Georg Thieme Verlag KG Stuttgart · New York
Disseminierte hormonbildende Leiomyomatose nach laparoskopischer suprazervikaler Hysterektomie: ein Fallbericht
Disseminated Hormone-Producing Leiomyomatosis after Laparoscopic Supracervical Hysterectomy: A Case ReportPublication History
eingereicht 6.9.2010
revidiert 13.10.2010
akzeptiert 13.10.2010
Publication Date:
26 November 2010 (online)
![](https://www.thieme-connect.de/media/gebfra/201011/lookinside/thumbnails/10.1055-s-0030-1250509-1.jpg)
Zusammenfassung
Im vorliegenden Fallbericht wird das Auftreten von multiplen peritonealen Leiomyomen, verbunden mit Endometriose und Endosalpingiose nach laparoskopischer suprazervikaler Hysterektomie mit Elektromorcellation, beschrieben. Interessanterweise kann die Korrelation der Serumöstradiolspiegel der Patientin mit dem Auftreten bzw. Vorhandensein von Leiomyomen auch nach bilateraler kompletter Adnexektomie gezeigt werden. Die Zunahme derartiger Fälle mit der Verbreitung der Elektromorcellation bei laparoskopischen Hysterektomien und Myomenukleationen wird ebenso diskutiert wie verschiedene Therapieansätze zur Behandlung der Tumoren. Die komplette Entfernung sämtlicher Gewebsfragmente wird als wichtiges Fazit für die Praxis hervorgehoben. Der mögliche Zusammenhang zu einer autokrinen Hormonproduktion durch die Tumoren muss weiter untersucht werden.
Abstract
The following case report describes the occurrence of multiple peritoneal leiomyomas associated with endometriosis and endosalpingiosis after laparoscopic supracervical hysterectomy using electromorcellation. Interestingly, we found a positive correlation between leiomyomas and serum estrogen levels even after bilateral adnexectomy. The increasing incidence of such cases after electromorcellation, a popular treatment approach, and the different therapeutic options for this metastatic tumor are discussed. The important conclusion for daily clinical practice is the necessity of completely removing all tissue fragments after morcellation. A correlation with autocrine hormone production in such tumors should be further investigated.
Schlüsselwörter
suprazervikale Hysterektomie - Leiomyomatose - Morcellation
Key words
supracervical hysterectomy - leiomyomatosis - morcellation
Literatur
- 1 Bekkers R L, Willemsen W N, Schijf C P et al. Leiomymatosis peritonealis disseminata: does malignant transformation occur? A literature review. Gynecol Oncol. 1999; 75 158-163
- 2 Bucher M, Pusztaszeri M, Bouzourene H. Leiomyomatosis peritonealis disseminata: immunhistochemical profile and origin. Ann Pathol. 2006; 26 207-210
- 3 Butnor K J, Burchette J L, Robboy S J. Progesterone receptor activity in leiomyomatosis peritonealis disseminata. Int J Gynecol Pathol. 1999; 18 259-264
- 4 Dallenbach C, Miklaw H, Dallenbach F D et al. Disseminated peritoneal leiomyomatosis. A rare disease picture. Geburtsh Frauenheilk. 1989; 49 201-204
- 5 Donnez O, Squifflet J, Leconte I et al. Posthysterectomy pelvic adenomyotic masses observed in 8 cases out of a series of 1405 laparoscopic subtotal hysterectomies. J Minim Invasive Gynecol. 2007; 14 156-160
- 6 Epstein J H, Nejat E J, Tsai T. Parasitic myomas after laparoscopic myomectomy: case report. Fertil Steril. 2009; 91 932.e13-932.e14
- 7 Fujii S, Nakashima N, Okamura H et al. Progesterone-induced smooth muscle-like cells in the subperitoneal nodules produced by estrogen. Experimental approach to leiomyomatosis peritonealis disseminata. Am J Obstet Gynecol. 1981; 139 164-172
- 8 Heinig J, Neff A, Cirkel U et al. Recurrent leiomyomatosis peritonealis disseminate after hysterectomy and bilateral salpingo-oophorectomy during combined hormone replacement therapy. Eur J Obstet Gynecol Reprod Biol. 2003; 111 216-218
- 9 Hilger W S, Magrina J F. Removal of pelvic leiomyomata and endometriosis five years after supracervikal hysterectomy. Obstet Gynecol. 2006; 108 (3 Pt 2) 772-774
- 10 Kokawa K, Yamoto M, Yata C et al. Postmenopausal intravenous leiomyomatosis with high levels of estradiol and estrogen receptor. Obstet Gynecol. 2002; 100 (5 Pt 2) 1124-1126
- 11 Kumar S, Sharma J B, Verma D et al. Disseminated peritoneal leiomyomatosis: an unusual complication of laparoscopic myomectomy. Arch Gynecol Obstet. 2008; 278 93-95
- 12 Lin Y C, Wei L H, Shun C T et al. Disseminated peritoneal leiomyomatosis responds to systemic chemotherapy. Oncology. 2009; 76 55-58
- 13 Miyake T, Enomoto T, Ueda Y et al. A case of disseminated peritoneal leiomyomatosis developing after laparoscopic-assisted myomectomy. Gynecol Obstet Invest. 2009; 67 96-102
- 14 Moon H S, Koo J S, Park S H et al. Parasitic leiomyoma in the abdominal wall after laparoscopic myomectomy. Fertil Steril. 2008; 90 1201.e1-1201.e2
- 15 Paul P G, Koshy A K. Multiple peritoneal parasitic myomas after laparoscopic myomectomy and morcellation. Fertil Steril. 2006; 85 492-493
- 16 Sinha R, Sundaram M, Mahajan C et al. Multiple leiomyomas after laparoscopic hysterectomy: report of two cases. J Minim Invasive Gynecol. 2007; 14 123-127
- 17 Strinic T, Kuzmic-Prusac I, Eterovic D et al. Leiomyomatosis peritonealis disseminata in a postmenopausal woman. Arch Gynecol Obstet. 2000; 264 97-98
- 18 Summa B, Schem C, Weigel M et al. Leiomyomatosis peritonealis disseminata in a pregnant woman. Arch Gynecol Obstet. 2009;
- 19 Takeda A, Mori M, Sakai K et al. Parasitic peritoneal leiomyomatosis diagnosed 6 years after laparoscopic myomectomy with electric tissue morcellation: report of a case and review of the literature. J Minim Invasive Gynecol. 2007; 14 770-775
- 20 Takeda T, Masuhara K, Kamiura S. Successful management of a leiomyomatosis peritonealis disseminate with an aromatase inhibitor. Obstet Gynecol. 2008; 112 (2 Pt 2) 491-493
- 21 Thian Y L, Tan K H, Kwek J W et al. Leiomyomatosis peritonealis disseminate and subcutaneous myoma – a rare complication of laparoscopic myomectomy. Abdom Imaging. 2009; 34 235-238
- 22 Varelas F K, Papanicolaou A N, Vavatsi-Christaki N et al. The effect of anastrozol on symptomatic uterine leiomyomata. Obstet Gynecol. 2007; 110 643-649
Dr. med. Harald Krentel
CEGPA – Centro de Endoscopía Ginecológica Peruano Aleman
Av. Guardia Civil 135
San Borja
Lima – Peru
Email: krentel@cegpa.org