[1123] Pathologic Abnormalities of Uteri Removed by Morcellation. A Review of 889 Cases.

Frida Rosenblum, Christopher N Otis. Baystate Medical Center/Tufts University Schoool of Medicine, Springfield, MA

Background: Minimally invasive surgery has become an accepted alternative to traditional open surgical techniques. Pelviscopic hysterectomy by morcellation (with or without adnexa) is now routinely performed at Baystate Health Systems. The purpose of this study was to review such specimens to determine the presence of abnormal findings which would traditionally be approached without morcellation.
Design: A search of the anatomic laboratory information system was performed to identify morcellation procedures on gynecologic specimens from 1-1-01 to 1-1-10. All findings were recorded. Pre and postoperative information was obtained from the electronic medical records when available (IRB# BH-10-077).
Results: A total of 889 cases were reviewed (64 had non-morcellated components). The two most common diagnoses were leiomyoma (719 cases, 81%) and adenomyosis (327 cases, 37%). There were 30 (4.1%) atypical smooth muscle tumors, including 2 leiomyosarcomas. 75 cases (8.4%) were considered to have unexpected and significant diagnoses (see table). One case of epithelioid STUMP recurred 6 years after original diagnosis as low grade leiomyosarcoma.

Selected Significant Diagnoses in Morcellated Specimens
Epithelioid smooth muscle tumor of undetermined malignant potential3
Endometrial stromal tumor with muscle differentiation1
Low grade endometrial stromal sarcoma1
Endometrioid adenocarcinoma3
Atypical endometrial hyperplasia (simple, complex, polyp)/atypical polypoid adenomyoma10
Ovarian brenner tumor1
Ovarian mature cystic teratoma2
Ovarian adult granulosa cell tumor1
Ovarian mullerian mucinous borderline tumor1
Ovarian serous borderline tumor1

Documented preoperative evaluation was limited, and when available did not indicate the presence of neoplastic disease.
Conclusions: This review confirms the presence of unexpected significant lesions of the endometrium, uterine stroma and smooth muscle, and ovary. The local recurrence of one smooth muscle tumor 6 years following diagnosis may reflect seeding of the operative field following morcellation. In summary, unexpected neoplastic lesions of the gynecologic tract occur following morcellation, which may adversely affect staging, patient management and potentially patient outcome.
Category: Gynecologic & Obstetrics

Monday, February 28, 2011 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 131, Monday Morning


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