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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 resected rectum. (A) The gross finding of the resected rectum. The arrow indicates metastatic lesions of the rectal surface, which has an irregular surface contour. The arrowhead indicates the adjacent normal rectal serosa. (B) Low-power field microscopy shows a tumor (T) of the rectal surface, muscle layer (Ms) and mucosal layer (Mu) of the rectum (H&E stain, ×20). (C) H&E stain, ×400. (D) Immunohistochemical staining shows a positive indication of CD10 (×200).
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Figure 2: The resected rectum. (A) The gross finding of the resected rectum. The arrow indicates metastatic lesions of the rectal surface, which has an irregular surface contour. The arrowhead indicates the adjacent normal rectal serosa. (B) Low-power field microscopy shows a tumor (T) of the rectal surface, muscle layer (Ms) and mucosal layer (Mu) of the rectum (H&E stain, ×20). (C) H&E stain, ×400. (D) Immunohistochemical staining shows a positive indication of CD10 (×200).

Mentions: Pathological examination of the tissue confirmed a metastatic LGESS involving the resected rectal serosal surface (Fig. 2). There were no other metastatic lesions. The LGESS was positive for the estrogen receptor, progesterone receptor, smooth muscle actin, CD10, P53, and Ki-67. The patient was diagnosed with stage IIB LGESS. Progesterone medication (medroxyprogesterone acetate 10 mg/day) was administered as a postoperative adjuvant treatment. There was no evidence of disease recurrence during the 12-month follow-up after reexploratory surgery.


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 resected rectum. (A) The gross finding of the resected rectum. The arrow indicates metastatic lesions of the rectal surface, which has an irregular surface contour. The arrowhead indicates the adjacent normal rectal serosa. (B) Low-power field microscopy shows a tumor (T) of the rectal surface, muscle layer (Ms) and mucosal layer (Mu) of the rectum (H&E stain, ×20). (C) H&E stain, ×400. (D) Immunohistochemical staining shows a positive indication of CD10 (×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: The resected rectum. (A) The gross finding of the resected rectum. The arrow indicates metastatic lesions of the rectal surface, which has an irregular surface contour. The arrowhead indicates the adjacent normal rectal serosa. (B) Low-power field microscopy shows a tumor (T) of the rectal surface, muscle layer (Ms) and mucosal layer (Mu) of the rectum (H&E stain, ×20). (C) H&E stain, ×400. (D) Immunohistochemical staining shows a positive indication of CD10 (×200).
Mentions: Pathological examination of the tissue confirmed a metastatic LGESS involving the resected rectal serosal surface (Fig. 2). There were no other metastatic lesions. The LGESS was positive for the estrogen receptor, progesterone receptor, smooth muscle actin, CD10, P53, and Ki-67. The patient was diagnosed with stage IIB LGESS. Progesterone medication (medroxyprogesterone acetate 10 mg/day) was administered as a postoperative adjuvant treatment. There was no evidence of disease recurrence during the 12-month follow-up after reexploratory surgery.

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