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[913] Vascular Pseudoinvasion in Laparoscopic Hysterectomy Specimens: A Diagnostic Pitfall

AV Herdman, KA Moller, S Logani. Emory University, Atlanta, GA; Southwest Gynecologic Oncology Associates Inc, Albuquerque, NM

Background: Laparoscopic hysterectomy has proven to be an equally effective and safe technique when compared to conventional abdominal surgery for endometrial carcinoma. The procedure, as performed at our institution, involves the use of a uterine balloon manipulator for surgical exposure. The fallopian tubes are either cauterized or ligated to prevent transtubal spread of the tumor. The inflated balloon manipulator thus creates a positive closed pressure system within the uterine cavity. We observed extensive tumor involvement of blood vessels in one case of grade 1, stage 1A endometrial carcinoma and postulated that the closed pressure system may cause tumor displacement into vascular spaces.
Design: Slides of hysterectomy specimens performed laparoscopically between August 2004 and March 2006 at Emory University Hospital were reviewed. Seven patients underwent laparoscopic hysterectomy for endometrial carcinoma or atypical complex hyperplasia (ACH) and 30 patients had surgery for benign uterine pathology. Six to 19 (average 12) slides from the tumor cases and 2 to 8 (average 4) slides from the benign hysterectomies were reviewed for the presence or absence of endometrial tumor/tissue in vascular spaces.
Results: Patients with endometrial carcinoma/ACH ranged from 54 to 72 years in age. These included 6 FIGO grade I endometrioid carcinomas (3 stage 1A; 3 stage 1B) and one patient with atypical complex hyperplasia. Tumor within blood vessels was noted in 5 of 7 (71%) cases. In 3 cases including the case of ACH, multiple small and large caliber blood vessels showed tumor. In the remainder, one case had 2 small vessels involved and in the other 7 small vessels showed tumor within vascular lumina. Patients who underwent hysterectomy for benign disease were relatively younger (median age 48 years). Benign endometrial glands and stromal tissue was noted within vascular spaces in 4 of 30 (13%) cases.
Conclusions: We describe a hitherto unreported artifact of vascular pseudoinvasion generated by the operative technique in laparoscopic hysterectomy specimens. This may have incorrect adverse therapeutic implications for the patient. We postulate that this artifact most likely results from the creation of a closed pressure system generated as part of the operative technique. Pathologists need to be aware of this potential artifact, especially if they encounter a significant number of laparoscopic hysterectomy specimens for endometrial carcinoma in their practice.
Category: Gynecologic

Monday, March 26, 2007 9:00 AM

Platform Session: Section C, Monday Morning