Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms.

<h4>Background</h4>Power morcellation has become a common technique for the minimally invasive resection of uterine leiomyomas. This technique is associated with dissemination of cellular material throughout the peritoneum. When morcellated uterine tumors are unexpectedly found to be lei...

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Autores principales:	Michael A Seidman, Titilope Oduyebo, Michael G Muto, Christopher P Crum, Marisa R Nucci, Bradley J Quade
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/14485dc719f04c86abe578d06375285e
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spelling	oai:doaj.org-article:14485dc719f04c86abe578d06375285e2021-11-18T08:07:35ZPeritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms.1932-620310.1371/journal.pone.0050058https://doaj.org/article/14485dc719f04c86abe578d06375285e2012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23189178/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Power morcellation has become a common technique for the minimally invasive resection of uterine leiomyomas. This technique is associated with dissemination of cellular material throughout the peritoneum. When morcellated uterine tumors are unexpectedly found to be leiomyosarcomas or tumors with atypical features (atypical leiomyoma, smooth muscle tumor of uncertain malignant potential), there may be significant clinical consequences. This study was undertaken to determine the frequency and clinical consequence of intraperitoneal dissemination of these neoplasms.<h4>Methodology/principal findings</h4>From 2005-2010, 1091 instances of uterine morcellation were identified at BWH. Unexpected diagnoses of leiomyoma variants or atypical and malignant smooth muscle tumors occurred in 1.2% of cases using power morcellation for uterine masses clinically presumed to be "fibroids" over this period, including one endometrial stromal sarcoma (ESS), one cellular leiomyoma (CL), six atypical leiomyomas (AL), three smooth muscle tumor of uncertain malignant potential (STUMPs), and one leiomyosarcoma (LMS). The rate of unexpected sarcoma after the laparoscopic morcellation procedure was 0.09%, 9-fold higher than the rate currently quoted to patients during pre-procedure briefing, and this rate may increase over time as diagnostically challenging or under-sampled tumors manifest their biological potential. Furthermore, when examining follow-up laparoscopies, both from in-house and consultation cases, disseminated disease occurred in 64.3% of all tumors (zero of one ESS, one of one CL, zero of one AL, four of four STUMPs, and four of seven LMS). Only disseminated leiomyosarcoma, however, was associated with mortality. Procedures are proposed for pathologic evaluation of morcellation specimens and associated follow-up specimens.<h4>Conclusions/significance</h4>While additional study is warranted, these data suggest uterine morcellation carries a risk of disseminating unexpected malignancy with apparent associated increase in mortality much higher than appreciated currently.Michael A SeidmanTitilope OduyeboMichael G MutoChristopher P CrumMarisa R NucciBradley J QuadePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 11, p e50058 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Michael A Seidman Titilope Oduyebo Michael G Muto Christopher P Crum Marisa R Nucci Bradley J Quade Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms.
description	<h4>Background</h4>Power morcellation has become a common technique for the minimally invasive resection of uterine leiomyomas. This technique is associated with dissemination of cellular material throughout the peritoneum. When morcellated uterine tumors are unexpectedly found to be leiomyosarcomas or tumors with atypical features (atypical leiomyoma, smooth muscle tumor of uncertain malignant potential), there may be significant clinical consequences. This study was undertaken to determine the frequency and clinical consequence of intraperitoneal dissemination of these neoplasms.<h4>Methodology/principal findings</h4>From 2005-2010, 1091 instances of uterine morcellation were identified at BWH. Unexpected diagnoses of leiomyoma variants or atypical and malignant smooth muscle tumors occurred in 1.2% of cases using power morcellation for uterine masses clinically presumed to be "fibroids" over this period, including one endometrial stromal sarcoma (ESS), one cellular leiomyoma (CL), six atypical leiomyomas (AL), three smooth muscle tumor of uncertain malignant potential (STUMPs), and one leiomyosarcoma (LMS). The rate of unexpected sarcoma after the laparoscopic morcellation procedure was 0.09%, 9-fold higher than the rate currently quoted to patients during pre-procedure briefing, and this rate may increase over time as diagnostically challenging or under-sampled tumors manifest their biological potential. Furthermore, when examining follow-up laparoscopies, both from in-house and consultation cases, disseminated disease occurred in 64.3% of all tumors (zero of one ESS, one of one CL, zero of one AL, four of four STUMPs, and four of seven LMS). Only disseminated leiomyosarcoma, however, was associated with mortality. Procedures are proposed for pathologic evaluation of morcellation specimens and associated follow-up specimens.<h4>Conclusions/significance</h4>While additional study is warranted, these data suggest uterine morcellation carries a risk of disseminating unexpected malignancy with apparent associated increase in mortality much higher than appreciated currently.
format	article
author	Michael A Seidman Titilope Oduyebo Michael G Muto Christopher P Crum Marisa R Nucci Bradley J Quade
author_facet	Michael A Seidman Titilope Oduyebo Michael G Muto Christopher P Crum Marisa R Nucci Bradley J Quade
author_sort	Michael A Seidman
title	Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms.
title_short	Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms.
title_full	Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms.
title_fullStr	Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms.
title_full_unstemmed	Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms.
title_sort	peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/14485dc719f04c86abe578d06375285e
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_version_	1718422154243997696

Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms.

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