ACCIDENTAL INTRAOPERATIVE FINDING OF PARASITIC FIBROIDS IN THE MESENTERY OF A MIDDLE-AGED WOMAN

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A.O. Bankole¹ , R.A. Abdus-Salam² , A.J. Fakoya³ , O.O. Adegoke⁴ , I.O. Morhason-Bello^2,5

1. Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
2. Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
3. Department of Surgery, University College Hospital, Ibadan, Nigeria.
4. Department of Pathology, University College Hospital, Ibadan, Nigeria.
5. Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Abstract

Fibroid (myoma) is the most common benign tumor of the female genital tract. The tumour may occur in the uterine corpus as intramural, submucous, subserous, cervical fibroid; or in the broad ligament as intraligamentary fibroid or outside of uterus as parasitic fibroid. Parasitic fibroid is rare as a primary or secondary tumour. It is commonly diagnosed as an incidental finding during radiologic or abdominal surgical procedures. This was a case report of histologically confirmed multiple parasitic ibroids in a 39-year-old woman coexisting with primary uterine fibroids. The woman presented with a history of progressive abdominal swelling and associated lower abdominal pain of 8 years duration. There was an antecedent history of exploratory laparotomy with excision of uterine mass. Abdominal ultrasonography revealed multiple uterine fibroid nodules in the submucous, intramural and subserous layers of the uterus with bilateral normal ovaries. She had abdominal myomectomy. The intraoperative findings revealed multiple uterine fibroid nodules with a total weight of 1670g. There were multiple parasitic fibroid nodules attached to the serosa of the colon with the largest measuring 3.5 x 2cm. We discussed the management and associated challenges of unanticipated parasitic fibroids at surgery. We highlighted the role of multi disciplinary care and advocated for a high index of suspicion while preparing for surgical intervention in women with multiple uterine fibroids.

Keywords: Uterine fibroids, Myoma, Fibroid location, Parasitic fibroid

Introduction

Uterine leiomyoma is the commonest benign tumour of the female genital tract consisting of uterine smooth muscle cells with varying amount of fibrous connective tissues. Although the real aetiology of uterine fibroids is unknown, the tumour is associated with several epidemiological risk factors. Some of the risk factors associated with uterine fibroids include age above 35years, low parity, obesity, being of black race, genetic factors, familial factors, and nutrients low in vitamin D amongst others.¹ The exact incidence or prevalence of fibroids is difficult to determine. Studies have reported an incidence rate of 190 per 100,000 to 270 per 100,000 women years in different populations.¹ Uterine fibroid was reported in 50-80% of pathological or postmortem specimens.^2,3 Generally, uterine fibroids is asymptomatic, mostly diagnosed accidentally during ultrasound; and only 20-50% become symptomatic.²

Generally, fibroids are classified based on their location within the uterus. They may be submucous, intramural, sub-serous, inter-ligamentous, cervical and parasitic.³ Parasitic or ectopic fibroids are rare intra-abdominal tumour usually with the same histological features with uterine fibroids.² In general, parasitic fibroids usually arise as projections from sub-serosal part of uterine fibroids. Afterwards, the growth rate of the serosal projections of these fibroids supersedes the primary vascular supply from the uterus leading to atrophy of the uterine myoma junction and subsequent detachment. During this period, the outgrown tumour will latch on the adjacent mesenteric vessels for its new blood supply.

We present a case of parasitic fibroids coexisting with uterine fibroids that was accidentally discovered during surgery in a middle-aged woman.