Prevalence of occult leiomyosarcomas and atypical leiomyomas after laparoscopic morcellation of leiomyomas in reproductive-age women

Pados, George; Tsolakidis, Dimitrios; Theodoulidis, V; Makedos, Anastasios; Zaramboukas, Thomas; Tarlatzis, Basil C.

doi:10.1093/humrep/dex258

Cited by 16 publications

(6 citation statements)

References 18 publications

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“…If our study design was based on a single MIS unit or MIS procedures only, we would have found no occult LMS cases as well as no occult LMS in women of reproductive age. Indeed, a recent case series of laparoscopic myomectomies in women of reproductive age reported no cases of LMS morcellation [16]. Based on these results and a recently suggested algorithm [18] for the use of power morcellation, one can suppose that morcellation in young women is very safe.…”

Section: Discussionmentioning

confidence: 88%

“…Thus, selection of specific centers and units (such as Gynecologic Oncology units) can overestimate the prevalence due to the higher-risk population treated. On the other hand, selected reports from only laparoscopic procedures or from only MIS centers may indicate a lower prevalence of occult LMS or risk of power morcellation [14][15][16] than multicenter studies [17].…”

Section: Discussionmentioning

confidence: 99%

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Occult uterine leiomyosarcoma in women undergoing abdominal and minimally invasive surgeries for myomas

2018

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Objectives: To estimate (i) the incidence of occult uterine leiomyosarcoma (LMS) in patients operated on for presumed myomas, and (ii) the proportion of occult LMS to preoperatively diagnosed LMS in a tertiary center. Material and methods: An Institutional Review Board-approved retrospective cohort study was performed. The electronic database of 30,476 patients was searched for women who had undergone surgery due to presumed myomas (N = 2675) as well as those with uterine LMS recognized via histology (N = 10) between January 2010 and December 2016. Results: Six of the 2675 treated women had occult LMS (incidence 1:446; 0.002; CI 0.0-0.013), and one underwent power morcellation (incidence 1:951; 0.001; CI 0.0-0.006). Parallel searching revealed that 6 of the 10 cases (60%) with uterine LMS recognized via histology were diagnosed postoperatively, whereas 4 of the 10 (40%) were diagnosed preoperatively. The incidence of LMS morcellation during laparoscopy was 1:951 and, when all MIS cases were included, 1:1178. The patient who underwent LMS morcellation was operated in the general surgery ward 5 years after laparoscopy (omental recurrence). Conclusions: These results are similar to the first and recent conservative FDA estimations, but two-times lower for procedures with laparoscopic morcellation and all MIS procedures than for abdominal. Because above half of LMS may be recognized after surgery, the risk of occult LMS and the delay of targeted surgical treatment should be included in all informed consent forms for conservative management of presumed myomas without histology.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Occult uterine leiomyosarcoma in women undergoing abdominal and minimally invasive surgeries for myomas

2018

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“…For patients undergoing myomectomy or hysterectomy, there was a warning, in April 2014, against the use of laparoscopic power morcellation by the FDA ( 8 ). Unexpected malignancy was estimated to occur in 1 out of 350 women ( 8 , 9 , 10 , 11 ). After this warning, several renowned hospitals across the world stopped using EMM.…”

Section: Introductionmentioning

confidence: 99%

Effect of tumor morcellation in patients with early uterine sarcoma: a multicenter study in Germany

Gitas¹,

Ertan²,

Baum³

et al. 2022

J Turkish German Gynecol Assoc

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The use of power morcellation at laparoscopy may worsen survival rates for patients with malignancy. The aim of the present study was to report the outcome of patients with early-stage uterine sarcoma after morcellation or total en-bloc resection, and evaluate potential signs of sarcoma preoperatively. Material and Methods: This multicenter retrospective study consisted of patients, who underwent surgery for FIGO-stage-I uterine sarcoma. Twenty-four patients were divided into a non-morcellation group and a morcellation group. Clinical records and the outcomes of patients, including one-, three-and five-year survival rates were reviewed. Preoperative characteristics of patients with sarcoma were compared to those of a control group with uterine myoma (1:4 ratio), matched by age and type of operation. Results: Obesity was an independent risk factor for uterine myoma. Tumor growth, solitary growth, largest-diameter lesion > 8.0 cm, and anechoic areas suggesting necrosis and increased vascularization were significantly more common in the sarcoma group. A large tumor diameter was significantly associated with mortality. Patients in the non-morcellation group had a slightly lower disease-free survival, but poorer overall survival rates compared to patients in the morcellation group, however both differences were not statistically significant. Patients in the nonmorcellation group, who had undergone a re-exploration experienced late recurrence, but we registered no upstaging after the operation. Conclusion: Preoperative ultrasound characteristics could be useful to distinguish sarcoma from leiomyoma of uterus. Morcellation of a sarcoma may increase abdominal and pelvic recurrence rates, but may not be associated with overall survival in patients with FIGO stage I disease.

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“…Population‐based estimates of the incidence of uterine sarcoma range from 1.55 to 1.95 per 100 000 women per year. It is estimated that 0.1–0.3% of patients operated on for presumed uterine leiomyoma have a uterine sarcoma.…”

Section: Introductionmentioning

confidence: 99%

Imaging in gynecological disease (15): clinical and ultrasound characteristics of uterine sarcoma

Ludovisi

Moro

Pasciuto

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To describe the clinical and ultrasound characteristics of uterine sarcomas. Methods This was a retrospective multicenter study. From the databases of 13 ultrasound centers, we identified patients with a histological diagnosis of uterine sarcoma with available ultrasound reports and ultrasound images who had undergone preoperative ultrasound examination between 1996 and 2016. As the first step, each author collected information from the original ultrasound reports from his/her own center on predefined ultrasound features of the tumors and by reviewing the ultrasound images to identify information on variables not described in the original report. As the second step, 16 ultrasound examiners reviewed the images electronically in a consensus meeting and described them using predetermined terminology. Results We identified 116 patients with leiomyosarcoma, 48 with endometrial stromal sarcoma and 31 with undifferentiated endometrial sarcoma. Median age of the patients was 56 years (range, 26–86 years). Most patients were symptomatic at diagnosis (164/183 (89.6%)), the most frequent presenting symptom being abnormal vaginal bleeding (91/183 (49.7%)). Patients with endometrial stromal sarcoma were younger than those with leiomyosarcoma and undifferentiated endometrial sarcoma (median age, 46 years vs 57 and 60 years, respectively). According to the assessment by the original ultrasound examiners, the median diameter of the largest tumor was 91 mm (range, 7–321 mm). Visible normal myometrium was reported in 149/195 (76.4%) cases, and 80.0% (156/195) of lesions were solitary. Most sarcomas (155/195 (79.5%)) were solid masses (> 80% solid tissue), and most manifested inhomogeneous echogenicity of the solid tissue (151/195 (77.4%)); one sarcoma was multilocular without solid components. Cystic areas were described in 87/195 (44.6%) tumors and most cyst cavities had irregular walls (67/87 (77.0%)). Internal shadowing was observed in 42/192 (21.9%) sarcomas and fan‐shaped shadowing in 4/192 (2.1%). Moderate or rich vascularization was found on color‐Doppler examination in 127/187 (67.9%) cases. In 153/195 (78.5%) sarcomas, the original ultrasound examiner suspected malignancy. Though there were some differences, the results of the first and second steps of the analysis were broadly similar. Conclusions Uterine sarcomas typically appear as solid masses with inhomogeneous echogenicity, sometimes with irregular cystic areas but only very occasionally with fan‐shaped shadowing. Most are moderately or very well vascularized. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Prevalence of occult leiomyosarcomas and atypical leiomyomas after laparoscopic morcellation of leiomyomas in reproductive-age women

Abstract: None.

Cited by 16 publications

References 18 publications

Occult uterine leiomyosarcoma in women undergoing abdominal and minimally invasive surgeries for myomas

Occult uterine leiomyosarcoma in women undergoing abdominal and minimally invasive surgeries for myomas

Effect of tumor morcellation in patients with early uterine sarcoma: a multicenter study in Germany

Imaging in gynecological disease (15): clinical and ultrasound characteristics of uterine sarcoma

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