Uterine sarcoma dissemination during myomectomy: If not “acceptable collateral damage,” is it possible to mitigate the risk?

Abstract

Uterine sarcomas are rare, but benign leiomyomas (fibroids) are extremely common and frequently require surgery: either hysterectomy or myomectomy. A rare but potentially devastating consequence of myomectomy is inadvertent incomplete resection of a uterine sarcoma, resulting in tumor dissemination and a worse prognosis. The authors discuss the acceptable level of risk and how such a risk could be mitigated.

Differential diagnosis between uterine sarcoma and leiomyoma using preoperative clinical characteristics

“…In clinical circumstances, uterine sarcoma is frequently misdiagnosed as benign uterine disease (leiomyoma or adenomyosis) and treated with laparoscopic tumor resection and morcellation, which can be a major cause of trocar site metastasis . Intraperitoneal morcellation is associated with a significantly increased risk of abdominal/pelvic recurrence ( P = 0.001) and with significantly shorter median recurrence‐free survival (10.8 months vs 39.6 months; P = 0.002) . Therefore, it is important to verify clinical key factors in the preoperative diagnosis of uterine sarcoma to avoid morcellation of the incidental sarcoma.…”

“…9 Intraperitoneal morcellation is associated with a significantly increased risk of abdominal/pelvic recurrence (P = 0.001) and with significantly shorter median recurrence-free survival (10.8 months vs 39.6 months; P = 0.002). 10 Therefore, it is important to verify clinical key factors in the preoperative diagnosis of uterine sarcoma to avoid morcellation of the incidental sarcoma.…”

Intraoperative Frozen Section Biopsy of Uterine Smooth Muscle Tumors

“…[9][10][11][12] If the resulting diagnosis is benign, the patient may be treated with myomectomy, which is highly relevant to preserving fertility in young women. 13,14 Limitations in the art of frozen sections have been well described, 9,11 but the difficulties in the frozen section diagnosis of uterine smooth muscle tumors have seldom been discussed in the literature. 15 It is important for pathologists to be aware of morphologic pitfalls.…”

“…They are requested when there is a preoperative clinical suspicion, inconclusive imaging studies, or unusual intraoperative appearance of the tumor, raising the concern of malignancy 9–12. If the resulting diagnosis is benign, the patient may be treated with myomectomy, which is highly relevant to preserving fertility in young women 13,14…”