Unsuspected Diagnosis of Uterine Leiomyosarcoma after Laparoscopic Myomectomy in an Isolated Bag

Abstract

Minimally invasive techniques are generally applied for patients suspected of having benign fibroids if medical treatment is insufficient. On the other hand, sometimes some occult carcinomas of uterus like leiomyosarcomas may be reported for the patients' applied morcellation. This condition is rare but outcomes are clinically significant. Fragmentation of occult sarcoma in the abdominal cavity without isolation bag results in widespread and poor survival. In this article, we report a case of 37-year-old woman suffering from pain due to unexpected leiomyosarcoma. Laparoscopic myomectomy was performed with power morcellation in an isolated bag. Although isolation bag is generally reported to be preventive, recurrence of sarcoma was seen at 5th month of follow-up. Even though morcellation within a bag seems to block wide spreading, dispersion of tumor cannot be stopped and more investigations have to be done.

Iatrogenic parasitic myoma and iatrogenic adenomyoma after laparoscopic morcellation: A mini-review

“…In 2016, the FDA approved the first bag for contained morcellation [52]. However, an in vitro study demonstrated that the risk of leakage and tissue dissemination still exists, depending on the insufflation pressure and material type of the bag [53], and the case of Süleyman Salman confirmed this issue [54]. Another in vivo study showed that some types of bags seem to be safe [55], [56], but the existing bags were not designed for power morcellation and, thus, risk spillage in the case of multiport laparoscopy.…”

Italian consensus conference on management of uterine sarcomas on behalf of S.I.G.O. (Societa’ italiana di Ginecologia E Ostetricia)

“…What to do in case of use of minimally invasive approach to myomectomy or surgical reexploration after the unexpected diagnosis of uterine sarcoma? If a mini-invasive approach is used, morcellation must be performed through endobag in order to reduce the risk of dissemination, although the safety of this procedure is still uncertain [47,48].…”