A case of unsuspected low-grade endometrial stromal sarcoma successfully treated with two minimally invasive surgeries

Abstract

It is relatively uncommon to treat patients with a preoperative diagnosis of benign leiomyoma that is then unexpectedly rediagnosed as malignant in postoperative histology. We report the case of a 55-year-old woman with low-grade endometrial stromal sarcoma who had been diagnosed as having uterine leiomyoma with myxoid degeneration by preoperative magnetic resonance imaging (MRI). She underwent a laparoscopic hysterectomy. The uterus, after being placed in a retrieval bag, was transvaginally morcellated to prevent spillage of the contents, as the MRI image appeared somewhat atypical. A retrospective survey of MRI findings affirmed that the muscle tissue had the appearance of a low-intensity band-like structure: bag of worms appearance. She underwent a laparoscopic bilateral salpingo-oophorectomy and remains recurrence-free. With somewhat atypical preoperative MRI, it is essential to prevent the spillage of the tumor content as no definitive preoperative exclusion of unsuspected mesenchymal malignancies is feasible.

Sarcoma del estroma endometrial de bajo grado

“…No obstante, al conservar los ovarios, la probabilidad de recidiva es cercana al 100% (3) . Debido a la elevada probabilidad de positividad de receptores hormonales en las células tumorales, algunos autores han sugerido la posibilidad de tratamiento con agonista de hormona liberadora de gonadotropinas para reducir el tamaño tumoral previo a la cirugía mediante un mecanismo hipoestrogénico (4) .…”

“…Los hallazgos histopatológicos clásicos son proliferación de células tumorales pequeñas con núcleos redondos u ovalados, similares a las células proliferativas del estroma endometrial. Su tratamiento es quirúrgico y se recomienda el seguimiento a largo plazo (4) . Se presenta un caso de sarcoma del estroma endometrial de bajo grado.…”

Blunt Tipped Forceps Guided Bag Placement when Contained Power Morcellation is Performed for Laparoscopic and Robotic Surgery

“…[ 1 ] In addition to leiomyosarcoma, there have been reports of postoperative diagnoses including endometrial cancer, cervical cancer, low-grade endometrial stromal sarcoma, and placental site trophoblastic tumor. [ 2 3 4 ] Currently, the Food and Drug Administration (FDA) recommends utilizing container bags when using power morcellation. [ 5 ] In this sense, the most important procedure for reducing cell spillage is the safe placement of the bag without damage.…”