Laparoscopic Myomectomy – Converting to Laparotomy for a Suspicious Intraoperative Appearance with Subsequent Benign Histology – a Pre- and Intra-Operative Dilemma

Abstract

Background

Although the most common uterine tumour is leiomyoma, the differential diagnoses also include the rarer adenomyoma and leiomyosarcoma. A lack of clear reliable clinical and radiological features makes the triage of uterine masses to the appropriate surgical procedure difficult. In the case of suspicious appearance of a presumed leiomyoma, an open surgical approach is recommended and morcellation is avoided.

Case

We present a case of a woman undergoing an elective laparoscopic myomectomy for a fibroid that appeared benign on ultrasound but had suspicious features intraoperatively. The operation was converted to a laparotomy to avoid the risk of morcellation-related seeding in the event that the histology was malignant. The histology was subsequently a benign exophytic adenomyoma.

Conclusion

The assessment of the nature of fibroids can be difficult both pre- and intraoperatively, and the need for difficult decision making to convert to open surgery during a laparoscopic myomectomy but with subsequent benign histology should be part of patient counselling.

Keywords:

• adenomyoma
• communication
• differential diagnosis
• converting to laparotomy
• morcellation risks
• histology

Written Informed Consent for Publication of the Case Details Was Obtained

This case report was exempt from the Institutional Review Broad at St Mary’s Hospital because it is a medical/educational activity that does not meet the DHHS definition of “research”.

Acknowledgment

Dr Viola Patrizia for providing histology images from the case and guiding on the histological diagnosis of adenomyomas.

Disclosure

The authors report no conflicts of interest in this work.