Risk of unexpected uterine leiomyosarcoma during laparoscopic procedures: Experience from a single tertiary institute in Italy

Abstract

Laparoscopic power morcellators are used during laparoscopic surgery to cut tissue into smaller pieces for removal through an incision site typically measuring 2 cm or less. They are often used in gallbladder, kidney, liver, and spleen removal surgery, and in hysterectomy and myomectomy for uterine fibroids-a common benign tumor in women. In contrast, uterine sarcomas are a heterogeneous group of tumors that are characterized by aggressive clinical behavior.Uterine sarcomas can be divided into three categories: (1) uterine leiomyosarcoma (anomalous proliferation of the myometrial layer of the uterus); (2) endometrial stromal sarcoma (anomalous proliferation of the connective tissue underlining the endometrium); and (3) undifferentiated sarcoma. Uterine sarcomas are rare, with an

Intravenous metastasis of unexpected uterine sarcoma in the context of uterine fibroids: case report and literature review

“…ESS is regarded as the second most prevalent uterine mesenchymal tumor after uterine leiomyoma ( 9 ),. The worldwide median age for the diagnosis of ESS diagnosis is 55 years ( 10 ). Most of the patients do not experience specific symptoms, and up to 25% of the patients may remain asymptomatic ( 2 ).…”

Rate of Leiomyosarcomas during Surgery for Uterine Fibroids: 8-Year Experience of a Single Center

“…Secondly, concerning imaging, the exam of choice is ultrasound combined with Doppler (by an experienced IOTA certified sonographer) and if a suspicious fibroid is identified, then a magnetic resonance imaging (MRI) is performed. Studies failed to show any superiority between the two modalities [5], so due to cost-effectiveness MRI is considered as a secondline imaging technique. Ultrasound findings that indicate a possible sarcoma are large or rapidly growing, unique heterogeneous ill-defined tumors with irregular distribution of vessels and a low resistance index but high systolic velocities (color score 3-4) [34].…”

“…Taking into consideration their microscopic pathologic features, known as Stanford criteria [3], they can be divided into four groups: (1) benign leiomyomas, (2) benign variants of leiomyomas (e.g., cellular or bizarre), (3) smooth muscle tumor of uncertain malignant potential (STUMP), and (4) sarcomas [4]. Sarcomas can be further categorized into: (a) leiomyosarcomas, (b) endometrial stromal sarcomas, and (c) undifferentiated sarcomas [5]. The Stanford criteria help to differentiate between malignant and benign variants of the fibroids based on the following criteria: (1) tumor cell necrosis (not infract necrosis), (2) diffuse moderate to severe cytological atypia, (3) increased mitotic activity (a mitotic count of at least 10 mitotic figures (MF)/10 high power fields (HPFs)).…”

Clinical features of uterine sarcomas presenting mainly with uterine masses: a retrospective study

“…Minimally invasive treatment of uterine fibroids requires morcellation to remove fibroids through a small excision. Morcellation can be manual or instrumental (power morcellation), both of which can affect patient prognosis [14]. The US Food and Drug Administration (FDA) warned about the use of morcellation in 2014 because of the risk of undiagnosed uLMS in women undergoing morcellation during laparoscopic hysterectomies and myomectomies [15].…”