Atsuo Itakura

Incidence and risk factors of parasitic myoma after laparoscopic myomectomy using uncontained power morcellation: Retrospective analysis of 87 patients who had a subsequent second laparoscopic surgery

AbstractAimStudies on parasitic myomas after laparoscopic morcellation are mainly limited to case reports, and the incidence and risk factors have not yet been well‐understood. We aimed to clarify the actual incidence and risk factors of parasitic myoma after laparoscopic myomectomy using uncontained power morcellation by reviewing cases with subsequent laparoscopic surgery.MethodsThis retrospective study included 87 patients who had laparoscopic myomectomy using uncontained power morcellation, followed by subsequent second laparoscopic surgery for gynecological disease between 2008 and 2021. First, the incidence and characteristics of parasitic myomas detected at the second laparoscopic surgery were reviewed. Second, patients were stratified according to the presence of parasitic myoma (PM+ and PM− groups), and risk factors were analyzed by comparing the background, intraoperative findings, and clinical course after laparoscopic myomectomy.ResultsOf the 87 patients, parasitic myomas were detected in 16 (18.4%). Twelve patients (75.0%) were asymptomatic and diagnosed incidentally during surgery. Two patients presented with acute abdomen requiring emergency surgery. Comparing the PM+ and PM− groups, the total weight of the enucleated myomas and the diameter of the largest myoma at the initial laparoscopic myomectomy were significantly greater in the PM+ group. Other factors, including age and number of enucleated myomas did not differ between the groups.ConclusionsThe actual incidence of parasitic myoma after laparoscopic myomectomy using uncontained power morcellation is higher than that previously reported. In laparoscopic power morcellation, large myomas increase the risk of developing parasitic myoma, and a containment bag system is expected to minimize this complication.

A case of transient hyperthyroidism induced by placental site trophoblastic tumor

AbstractWe report a case of placental site trophoblastic tumor (PSTT) with transient hyperthyroidism. A 29‐year‐old gravida 2 para 2 woman presented with abnormal genital bleeding 6 months after delivery. Endometrial histology suggested PSTT. Serum human chorionic gonadotropin (hCG) was 117 mIU/mL and serum estradiol (E2) were 51 pg/mL. She reported increased appetite, sweating, fatigue, and 7‐kg weight loss within 3 months. Blood samples showed a thyroid‐stimulating hormone (TSH) level <0.01 μIU/mL, FT3: 24.3 pg/mL, FT4: 5.3 ng/mL. The patient was diagnosed with hyperthyroidism. After thyroid function normalized, laparoscopic hysterectomy and bilateral salpingectomy were performed. Two years postsurgery, there was no recurrence, and thyroid function improved. The hCG produced from gestational trophoblastic disease has stronger TSH activity than that from gestational trophoblasts. However, in PSTT, the E2 level, which increases thyroid‐binding proteins and suppresses elevated thyroid hormone levels, is low and may induce hyperthyroidism. In cases of suspected PSTT, thyroid function should be evaluated when hyperthyroid symptoms are present.

Current state of management of struma ovarii and preoperative imaging features: A retrospective case series study of 18 patients at a single institution

AbstractAimEven though 95% of struma ovarii are benign, it is often overtreated because of the difficulty to distinguish it from malignancy. In this study, our aim was to evaluate the current state of the preoperative diagnosis and the selection of the surgical procedure, and to improve preoperative diagnostic accuracy by retrospectively reviewing imaging findings.MethodsWe retrospectively reviewed the clinical course and imaging characteristics of 18 patients who were diagnosed postoperatively with struma ovarii, pathologically, at our institution between 2015 and 2021.ResultsThe preoperative diagnoses included benign ovarian tumor in eight cases, borderline in four cases, and malignant in six cases. None of the cases were diagnosed as struma ovarii preoperatively. Of the seven patients who had confirmed a desire for future childbearing, four patients were suspected for borderline or malignant tumor preoperatively, and underwent abdominal adnexectomy. In patients without a desire for childbearing, laparoscopic surgery was performed in only 45% of the patients whose preoperative diagnosis was benign. On magnetic resonance imaging (MRI), 54% of the cases showed enhanced solid components, which is characteristic of malignant tumors, but diffusion restriction was observed in only 11%. On computed tomography (CT), 78% of the cases showed a high attenuation lesion reflecting thyroid tissue.ConclusionsStruma ovarii is difficult to distinguish from malignancy preoperatively, making the choice of surgical approach complicated. A comprehensive evaluation of diffusion‐weighted MRI and CT findings may improve the accuracy of preoperative diagnosis of struma ovarii.