Morcellation Leading to Peritoneal Dissemination of Gynecologic Lesions
MA Seidman, AL Pelletier, MG Muto, CP Crum, P Dal Cin, MR Nucci, BJ Quade. Brigham and Women's Hospital, Boston, MA
Background: Uterine morcellation is a technique that allows for laparoscopic removal of large lesions, e.g. leiomyomata, by fragmentation. Although decreasing recovery time for the patient, it recently has been suggested that morcellation can result in microscopic seeding of the primary lesion throughout the peritoneum. Additionally, although recommended for lesions with low suspicion for malignancy, some tumors assessed clinically as benign may be revealed to have unexpected malignant potential upon histologic examination.
Design: Over the past 3 years, a series of 8 cases of both benign and malignant gynecologic smooth muscle tumors evaluated for iatrogenic dissemination following morcellation were culled from our pathology files. Follow-up was obtained by reviewing the electronic medical record.
Results: Two cases were morcellations of benign leiomyomata, one associated 7-years later with disseminated peritoneal leiomyomatosis (DPL) with cytogenetic clonality, the other with DPL 1-year post morcellation and disseminated leiomyosarcoma (LMS) 2-years post morcellation. One case of uterine stromal sarcoma revealed no dissemination 7-weeks post morcellation. A case of atypical smooth muscle tumor was associated with foci of dissemination as well as endometriosis just over 4-years post morcellation. Two cases of smooth muscle tumor of uncertain malignant potential (STUMP) were associated 2-months later with apparent dissemination. Two LMS cases were identified, one apparently associated with a benign peritoneal leiomyoma 1-month post morcellation, the other with overt dissemination with cytogenetic clonality 2-weeks post morcellation. Peritoneal cytology at the time of re-exploration was negative in all cases. All patients are alive at this time, most without therapy; both cases of disseminated LMS have received chemotherapy and are currently asymptomatic.
Conclusions: These findings underscore the potential risk of intraperitoneal dissemination following morcellation, emphasizing the need for appropriate patient consent procedures to explain the procedural risks weighed against the benefits of reduced recovery time, and, more importantly, for strict guidelines for selecting individuals for morcellation procedures. Further analysis of these tumors may identify pathological factors required for survival in distant sites.
Category: Gynecologic & Obstetrics
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 160, Monday Morning