Peritoneal leiomyomatosis after uterine fibroid morcellation

Case contributed by Michael P Hartung


Abdominal discomfort. Remote history of hysterectomy for fibroids.

Patient Data

Age: 40 years
Gender: Female

Numerous lobulated enhancing masses in the left lower abdomen and pelvis of varying sizes. Notice most masses have central areas of decreased enhancement. 

Ultrasound-guided biopsy

Vascular, hypoechoic masses correspond to the CT findings, targeted for ultrasound-guided biopsy. 

6 years prior (before hysterectomy)


Large, enhancing anterior fundal intramural fibroid. 

Case Discussion

Rare care of disseminated peritoneal leiomyomatosis caused by a complication of laparoscopic supracervical hysterectomy utilizing a power morcellator, which essentially seeded the peritoneal cavity with leiomyomas. This technique is no longer used for obvious reasons, which places these patients at risk for intraperitoneal spillage of benign (as in this case) or malignant tissue (e.g. leiomyosarcoma)1. The diagnosis with confirmed with ultrasound-guided biopsy with final pathology of leiomyoma. Although rare, this diagnosis was suspected due to the remarkably similar appearance of the peritoneal masses compared the large uterine fibroid before removal. 

Case courtesy of Dr. Perry Pickhardt 

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