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Intrapelvic dissemination of early low-grade endometrioid stromal sarcoma due to electronic morcellation.

Choo KJ, Lee HJ, Lee TS, Kim JH, Koh SB, Choi YS - Obstet Gynecol Sci (2015)

Bottom Line: Ultrasonographic findings of LGESS resemble those of submucosal myomas, leading to the possible preoperative misdiagnosis of LGESS as uterine leiomyoma.Electronic morcellation during laparoscopic surgery in women with LGESS can result in iatrogenic intraabdominal dissemination and a poorer prognosis.In conclusion, when LGESS is found incidentally following previous morcellation during laparoscopic surgery for presumed benign uterine disease, we highly recommend surgical reexploration, even when there is no evidence of a metastatic lesion in imaging studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea.

ABSTRACT
Endometrioid stromal sarcoma is a rare malignancy that originates from mesenchymal cells. It is classified into low-grade endometrioid stromal sarcoma (LGESS) and high-grade endometrioid stromal sarcoma. Ultrasonographic findings of LGESS resemble those of submucosal myomas, leading to the possible preoperative misdiagnosis of LGESS as uterine leiomyoma. Electronic morcellation during laparoscopic surgery in women with LGESS can result in iatrogenic intraabdominal dissemination and a poorer prognosis. Here, we report a patient with LGESS who underwent a supracervical hysterectomy and electronic morcellation for a presumed myoma in another hospital. Disseminated metastatic lesions of LGESS in the posterior cul-de-sac and rectal serosal surface were absent on primary surgery, but found during reexploration. In conclusion, when LGESS is found incidentally following previous morcellation during laparoscopic surgery for presumed benign uterine disease, we highly recommend surgical reexploration, even when there is no evidence of a metastatic lesion in imaging studies.

No MeSH data available.


Related in: MedlinePlus

The initial surgical findings of the rectal surface. The figure shows the abdominopelvic cavity after removal of the uterus by supracervical hysterectomy. There is no sign of metastasis in the rectal surface (arrow, rectal surface; arrowhead, remnant electrocauterized cervix).
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Figure 1: The initial surgical findings of the rectal surface. The figure shows the abdominopelvic cavity after removal of the uterus by supracervical hysterectomy. There is no sign of metastasis in the rectal surface (arrow, rectal surface; arrowhead, remnant electrocauterized cervix).

Mentions: The Postoperative course was uneventful. We reviewed the video recording of the initial surgery at the other hospital, and found no abnormal lesions on the rectal surface (Fig. 1). Given the findings on initial and reexploratory surgery, the rectal metastasis was likely due to dissemination from the electronic morcellation.


Intrapelvic dissemination of early low-grade endometrioid stromal sarcoma due to electronic morcellation.

Choo KJ, Lee HJ, Lee TS, Kim JH, Koh SB, Choi YS - Obstet Gynecol Sci (2015)

The initial surgical findings of the rectal surface. The figure shows the abdominopelvic cavity after removal of the uterus by supracervical hysterectomy. There is no sign of metastasis in the rectal surface (arrow, rectal surface; arrowhead, remnant electrocauterized cervix).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4588849&req=5

Figure 1: The initial surgical findings of the rectal surface. The figure shows the abdominopelvic cavity after removal of the uterus by supracervical hysterectomy. There is no sign of metastasis in the rectal surface (arrow, rectal surface; arrowhead, remnant electrocauterized cervix).
Mentions: The Postoperative course was uneventful. We reviewed the video recording of the initial surgery at the other hospital, and found no abnormal lesions on the rectal surface (Fig. 1). Given the findings on initial and reexploratory surgery, the rectal metastasis was likely due to dissemination from the electronic morcellation.

Bottom Line: Ultrasonographic findings of LGESS resemble those of submucosal myomas, leading to the possible preoperative misdiagnosis of LGESS as uterine leiomyoma.Electronic morcellation during laparoscopic surgery in women with LGESS can result in iatrogenic intraabdominal dissemination and a poorer prognosis.In conclusion, when LGESS is found incidentally following previous morcellation during laparoscopic surgery for presumed benign uterine disease, we highly recommend surgical reexploration, even when there is no evidence of a metastatic lesion in imaging studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea.

ABSTRACT
Endometrioid stromal sarcoma is a rare malignancy that originates from mesenchymal cells. It is classified into low-grade endometrioid stromal sarcoma (LGESS) and high-grade endometrioid stromal sarcoma. Ultrasonographic findings of LGESS resemble those of submucosal myomas, leading to the possible preoperative misdiagnosis of LGESS as uterine leiomyoma. Electronic morcellation during laparoscopic surgery in women with LGESS can result in iatrogenic intraabdominal dissemination and a poorer prognosis. Here, we report a patient with LGESS who underwent a supracervical hysterectomy and electronic morcellation for a presumed myoma in another hospital. Disseminated metastatic lesions of LGESS in the posterior cul-de-sac and rectal serosal surface were absent on primary surgery, but found during reexploration. In conclusion, when LGESS is found incidentally following previous morcellation during laparoscopic surgery for presumed benign uterine disease, we highly recommend surgical reexploration, even when there is no evidence of a metastatic lesion in imaging studies.

No MeSH data available.


Related in: MedlinePlus