Highlights
- •Morcellation appears to be changing the natural history of uterine leiomyosarcoma (ULMS) and smooth muscle tumor of uncertain-potential (STUMP).
- •Patients with morcellated sarcomas appear to be at an increased risk for disseminated intraperitoneal recurrence.
- •Surgical re-exploration may yield useful information regarding staging in patients with incidental ULMS/STUMP after morcellation for presumed benign disease.
Abstract
Objective
To describe the role of immediate re-exploration in patients with inadvertently morcellated
uterine leiomyosarcoma (ULMS) and smooth muscle tumors of uncertain malignant potential
(STUMP).
Methods
All patients with ULMS/STUMP who were managed or referred to the participating institutions
from January 2005 to January 2012 following minimally invasive gynecology surgery
with morcellation were detected through the pathology database. The diagnosis was
confirmed by gynecologic-pathologists following post-surgery pathology review.
Results
Twenty-one patients with the diagnosis of ULMS (N = 15) and STUMP (N = 6) after morcellation were identified. The median age of occurrence was 46 years (range, 25–58 years). Median follow-up duration was 27 months (range, 1.8–93.1 months). None of the 21 patients had documented evidence of extra-uterine disease
at the time of original surgery. Ultimately 12 patients were immediately re-explored
to complete staging. The median time to the staging surgery was 33 days (range 15–118 days). Two (28.5%) out of seven patients with presumed stage I ULMS and one (25%)
out of four patients with presumed stage I STUMP had significant findings of disseminated
intraperitoneal disease detected at immediate surgical re-exploration. One of the
8 patients with confined early ULMS and STUMP at the second surgery had intraperitoneal
recurrence, while the remaining 7 patients have had no recurrence and remain disease
free.
Conclusion
Surgical re-exploration is likely to show findings of disseminated peritoneal sarcomatosis
in a significant number of patients diagnosed with ULMS after a morcellation procedure.
Findings from re-exploration can contribute to the knowledge of natural history of
morcellated ULMS/STUMP and allow for accurate prognostication.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gynecologic OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence.Am J Obstet Gynecol. 2003; 188: 100-107
- Uterine myomas: an overview of development, clinical features, and management.Obstet Gynecol. 2004; 104: 393-406
- Leiomyosarcomas: clinical presentation.Am J Obstet Gynecol. 1993; 168: 180-183
- Leiomyosarcoma in a series of hysterectomies performed for presumed uterine leiomyomas.Am J Obstet Gynecol. 1990; 162: 968-974
- The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma.Gynecol Oncol. 2011; 122: 255-259
- Management of uterine malignancy found incidentally after supracervical hysterectomy or uterine morcellation for presumed benign disease.Int J Gynecol Cancer. 2008; 18: 1065-1070
- FIGO staging for uterine sarcomas.Int J Gynaecol Obstet. 2009; 104: 177-178
- Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology. Results of a meta-analysis.Hum Reprod. 2002; 17: 1334-1342
- Leiomyomatosis peritonealis disseminata: does malignant transformation occur? A literature review.Gynecol Oncol. 1999; 75: 158-163
- Parasitic myomas after laparoscopic surgery: an emerging complication in the use of morcellator? Description of four cases.Fertil Steril. 2011; 96: e90-e96
- Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity.Obstet Gynecol. 1993; 81: 471-474
- “Iatrogenic” parasitic myomas: unusual late complication of laparoscopic morcellation procedures.J Minim Invasive Gynecol. 2010; 17: 719-724
- Uterine leiomyosarcoma: does the primary surgical procedure matter?.Int J Gynecol Cancer. 2009; 19: 257-260
- Incidence of lymph node and ovarian metastases in leiomyosarcoma of the uterus.Gynecol Oncol. 2003; 91: 209-212
- Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms.PLoS One. 2012; 7: e50058
- Uterine smooth muscle tumors other than the ordinary leiomyomas and leiomyosarcomas: a review of selected variants with emphasis on recent advances and unusual morphology that may cause concern for malignancy.Adv Anat Pathol. 2010; 2: 91-112
- Adjuvant therapy for high-grade, uterus-limited leiomyosarcoma: results of a phase 2 trial (SARC 005).Cancer. 2013; 8: 1555-1561
- Surveillance, epidemiology, and end results analysis of 2677 cases of uterine sarcoma 1989–1999.Gynecol Oncol. 2004; 93: 204-208
- Adjuvant gemcitabine plus docetaxel for completely resected stages I–IV high grade uterine leiomyosarcoma: results of a prospective study.Gynecol Oncol. 2009; 112: 563-567
- Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874).Eur J Cancer. 2008; 44: 808-818
Article info
Publication history
Published online: December 30, 2013
Accepted:
November 21,
2013
Received:
August 30,
2013
Footnotes
☆An abstract of this manuscript was presented at the Society of Gynecologic Oncology meeting, Los Angeles, March, 2012.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
