case_images: PMC11647432_01
case_images: (a) Preoperative contrast-enhanced computed tomography (CT) images from a laparoscopic myomectomy performed at a different hospital 6 years prior. One uterine myoma is found in the uterine body (arrows). (b) Preoperative T2-weighted magnetic resonance images (MRI). The uterine body is enlarged, especially in the anterior wall, and many uterine myoma-like mass lesions are observed in the uterine cavity and muscle layers (thin arrows). Furthermore, many nodular lesions (arrowheads) with contrast effects and mild diffusion restriction are seen in the abdominal cavity on contrast-enhanced MRI (data not shown). A cystic lesion with a liquid surface formation is observed in the Douglas pouch, suspected to be an endometrial cyst or a peritoneal inclusion cyst (thick arrow). (c-f) Preoperative contrast-enhanced CT images. Numerous nodular lesions of various sizes with contrast effects and clear borders throughout the entire abdominal area. A similar nodule is also observed in one location in the right lower lobe of the lung (arrow).
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case_images: A preoperative contrast-enhanced computed tomography (CT) scan is shown in Figure 1a (magnetic resonance imaging [MRI] was likely avoided because of tattoos). Contrast-enhanced MRI revealed that the uterine body was enlarged, especially in the anterior wall, and many uterine myoma-like mass lesions were observed in the uterine cavity and muscle layers (Figure 1b, thin arrows). Furthermore, many nodular lesions with contrast effects and mild diffusion restriction were observed in the abdominal cavity (Figure 1b, arrowheads). A cystic lesion with a liquid surface formation was observed in the Douglas pouch, which was suspected to be an endometrial cyst or a peritoneal inclusion cyst (Figure 1b, thick arrow). Contrast-enhanced CT revealed numerous nodular lesions of various sizes with contrast effects and clear borders throughout the abdominal area, including the omentum and mesentery (Figure 1d-f). A similar nodule was observed in the right lower lobe of the lung (Figure 1c, arrow).
case_images: Findings from single-port laparoscopic and hysteroscopic surgery. (a-d) Numerous hard white masses, ranging from 1 mm to approximately 55 mm in size, were found in the abdominal cavity. (e, f) Several submucosal myomas are observed in the uterine cavity.
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case_images: PMC11647432_01_JOG-51-0-g002.jpg
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case_images: Numerous hard white masses, ranging from 1 mm to approximately 55 mm in size, were found in the abdominal cavity (Figure 2a-d). Soft membranous adhesions and adhesion cysts were found around the uterus; however, they were easily detachable, and uterine mobility was good (Figure 2c,d). No gross abnormalities were observed in the adnexa on either side (Figure 2d, arrows). Hysteroscopy revealed several submucosal myomas in the uterine cavity (Figure 2e,f).
case_images: Histopathological findings. (a) Multiple solid nodules attached to the peritoneal adipose tissue (x1.25). (b) Spindle-shaped cells with bland nuclei arranged in fascicles and bundles (x20). (c-f) Immunohistochemical findings. The tumor cells are positive for desmin (c), smooth muscle actin (d), estrogen receptor (e), and progesterone receptor (f). (x20).
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case_images: PMC11647432_01_JOG-51-0-g003.jpg
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case_images: Postoperative histopathological examination revealed multiple intraperitoneal (Figure 3a) and submucosal nodules, both with the same characteristics. The tumor cells had cytologically bland, uniform nuclei with fine chromatin and small nucleoli (Figure 3b). Immunohistochemical staining showed that the tumor cells were positive for desmin, smooth muscle actin, estrogen receptor, and progesterone receptor (Figure 3c-f) and focally positive for PAX8.