Tongfu Feng

Cellular leiomyoma: A 10‐year retrospective analysis of clinical features, and recurrence risk

Abstract Objectives In this study, we aimed to compare the clinical characteristics of cellular leiomyoma (CL) with those of typical uterine leiomyoma (UL) and explore recurrence risk factors in patients with CL myomectomy. Study Design In this retrospective cohort study, we analyzed medical records of patients diagnosed with CL ( n  = 102) and UL ( n  = 105) who underwent surgery between January 2013 and May 2023. Postoperative prognosis was assessed through patient follow‐up until June 2024. Results Patients with CL were likelier to have adenomyosis (odds ratio [OR], 4.06; 95% confidence interval [CI], 1.28–12.88; p  = 0.017) and late‐age menarche (OR, 1.50; 95% CI, 1.15–1.95; p  = 0.002). A uterus that has three or fewer fibroids (OR, 2.14; 95% CI, 1.05–4.37; p  = 0.037) was more likely to develop into CL than the control group. Concerning the predictive aspect, more than three fibroids are associated with a higher risk of recurrence (OR, 5.33; 95% CI, 1.02–27.76; p  = 0.047). The use of hysteroscopy to remove submucosal fibroids is associated with a lower risk (OR, 0.08; 95% CI, 0.01–0.78; p  = 0.030). Conclusions This study confirms that CL exhibits distinct clinical characteristics from ULs, with a higher postoperative recurrence rate and risks of malignant transformation and abdominal dissemination. Our study identified for the first time that adenomyosis is an independent risk factor for CL. Additionally, submucous fibroids tend to be resected while still small, allowing for more complete removal and reducing recurrence risk. An increased number of fibroids was also identified as a risk factor for recurrence.

Recurrence complicated with peritoneal dissemination after single-port gasless myomectomy for cellular uterine leiomyoma: A case report and literature review

Rationale: Cellular uterine leiomyomas (CL) represent the prevailing subtype among uterine leiomyomas. In this study, we report a case of recurrent peritoneal disseminated uterine fibroids 2 years after single-port laparoscopic gasless myomectomy. This article endeavors to examine the potential limitations of the aforementioned surgical procedure and outline the distinguishing features of recurrent cases with primary postoperative pathology as CL. Additionally, it aims to provide a summary of previous retrospective studies on CL and propose the existence of immunohistochemical molecules that may serve as predictors for the postoperative recurrence of cellular uterine fibroids. The ultimate objective is to enhance clinicians’ comprehension of the disease. Patient concerns: Two years ago, the patient underwent a single-port gasless laparoscopic myomectomy for uterine fibroids. Gynecological color Doppler ultrasound conducted 3 months ago revealed recurrence of uterine fibroids, and the patient experienced abdominal distension, mild urinary frequency, and constipation for the past month. Diagnoses: After the second surgical procedure, a comprehensive pathological examination and immunohistochemical analysis of both the uterine mass and metastatic lesions revealed that the definitive diagnosis was CLs. Interventions: The patient underwent the total hysterectomy, bilateral salpingectomy, pelvic adhesiolysis, omental mass resection, mesenteric mass resection, and pelvic peritoneal mass resection. All specimens were sent for rapid frozen examination and showed to be leiomyomas. Outcomes: The patient was discharged from the hospital on the 10th day after the operation. At the date of writing the article, the patient had no recurrence for 1 year and 5 months. Lessons: The single-port gasless approach did not achieve the desired reduction in fibroid recurrence, as anticipated by the surgeon. The act of pulling the tumor towards the abdominal incision for resection, on the contrary, may serve as an iatrogenic factor contributing to postoperative recurrence of CL into peritoneal dissemination leiomyomatosis. The single-port gasless assisted bag may be a more suitable option for myomectomy. The utmost effort should be made to prevent the potential recurrence of myoma caused by iatrogenic factors.