Case report: Hidden risk of disseminated leiomyomatosis after hysteroscopic myomectomy for submucous fibroid.

INTRODUCTION

Leiomyomatosis disseminata is a rare disease that can be challenging to diagnose. In this report, we present a case of Leiomyomatosis disseminata 1 year after hysteroscopic myomectomy with an intrauterine shaver.

PRESENTATION OF CASE: 35-year-old woman presented with severe menorrhagia and multiple fibroids, including submucous fibroids. She underwent hysteroscopic myomectomy with an intrauterine shaver and a diagnostic second-look hysteroscopy one month later to assess for intrauterine adhesions. One year later, as part of her preparation for in-vitro fertilization (IVF), she was advised to undergo laparoscopic myomectomy and hysteroscopy for removal of an intramural fibroid and to evaluate the endometrial cavity. During laparoscopic exploration, multiple small seedling myoma-like lesions were identified on the uterine surface. Histopathological analysis confirmed that the lesions were consistent with fibroids. The patient successfully conceived after eight months via IVF and delivered by Caesarean section.

DISCUSSION: This case highlights the rare occurrence of disseminated leiomyomatosis following hysteroscopic myomectomies with an intrauterine shaver and resectoscope. The suspected mechanism involves the migration of myomatous fragments through the Fallopian tubes, resulting in the implantation of multiple small fibroid-like lesions.

CONCLUSION

This case suggests a need for heightened awareness of this potential complication, improving surgical technique for prevention and diligent postoperative evaluation for development of this condition.