Parasitic myoma
Clinical presentations	Diagnostic tools	Differential diagnosis	Treatment modalities	Follow-up
Symptoms Abdominal/ pelvic pain (most common) Compression of adjacent organs Dysmenorrhea Signs Pelvic mass Abdominal distension Vaginal bleeding Asymptomatic <10% of cases	Abdominal US and/or TVUS Initial evaluation but limited specificity Pelvic MRI Preferred for better characterize extent, and consistency Abdominal CT To assess the extent, to exclude the presence of other abdominal lesions PET-CT/MRI If malignancy is suspected Histopathology To obtain definitive diagnosis	Ovarian lesions Leiomyosarcoma Peritoneal carcinomatosis Endometriosis with deep infiltration GISTs Peritoneal tuberculosis Sarcomatosis	Multidisciplinary discussion To determine the best therapeutical approach, the potential surgical radicality, and patient’s operability Debulking surgery Most effective LPT vs. LPS Depending on position, and size of lesion Morcellation It should be avoided, containment bags should be used Hormonal treatment It should be considered in case of patients unfit for surgery or as maintenance therapy after surgery	Not-well defined TVUS and/or RMI To evaluate regression, progression, or recurrence Re-excision It may be considered in case of residual lesions, or recurrences
US: ultrasound; TVUS: trans-vaginal ultrasound; MRI: magnetic resonance imaging; CT: computed tomography; PET: positron emission tomography; GISTs: gastrointestinal stromal tumors; LPT: laparotomy; LPS: laparoscopy.