What is a true spontaneous parasitic leiomyoma? A case-based review and reappraisal of the literature
European Journal of Obstetrics and Gynecology and Reproductive Biology, cilt.325, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Derleme
- Cilt numarası: 325
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.ejogrb.2026.115337
- Dergi Adı: European Journal of Obstetrics and Gynecology and Reproductive Biology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO)
- Anahtar Kelimeler: Diagnostic criteria, Extra-uterine leiomyoma, Spontaneous parasitic leiomyoma
- Acıbadem Mehmet Ali Aydınlar Üniversitesi Adresli: Evet
Özet
Objective: Spontaneous parasitic leiomyoma is a rare and poorly defined entity characterized by a lack of uterine attachment and acquisition of an extra-uterine blood supply in the absence of prior surgery. This study aimed to present a case of spontaneous parasitic leiomyoma and to critically re-evaluate the literature using strict diagnostic criteria to clarify its definition and pathogenesis. Methods: A structured literature review was conducted using PubMed/MEDLINE, Google Scholar, Web of Science, and ScienceDirect. Cases were included only if they met the criteria for true parasitic leiomyoma: complete detachment from the uterus and independent extra-uterine vascular supply without prior uterine surgery. Clinical, radiological, intraoperative, and histopathological data were extracted and analyzed. A total of 51 previously reported cases were identified, and one additional case from our institution was included. Results: A total of 52 histopathologically confirmed cases were analyzed. Patients ranged from 20 to 78 years of age, with the majority in the reproductive age group. The most common presenting symptoms were abdominal pain, distension, and palpable mass. The most frequent tumor locations included the greater omentum, peritoneum, and mesentery. Preoperative diagnosis was often challenging, with many cases misinterpreted as ovarian or gastrointestinal malignancies. Our findings demonstrate significant heterogeneity in the literature, with frequent misclassification of pedunculated subserosal fibroids and primary extra-uterine leiomyomas as parasitic lesions. Based on the reviewed cases, a stepwise evolutionary pathway involving detachment, migration, adhesion, and revascularization is proposed. Conclusion: Spontaneous parasitic leiomyoma represents a dynamic and evolving process rather than a static entity. Strict diagnostic criteria are essential to distinguish true parasitic leiomyomas from other extra-uterine smooth muscle tumors and iatrogenic implants. Standardization of terminology and diagnostic approach may improve classification accuracy and enhance understanding of this rare condition.