The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma

Park, Jeong-Yeol; Park, Sun-Kyung; Kim, Dae-Yeon; Kim, Jong-Hyeok; Kim, Yong‐Man; Kim, Young‐Tak; Nam, Joo‐Hyun

doi:10.1016/j.ygyno.2011.04.021

Cited by 303 publications

(161 citation statements)

References 17 publications

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“…Ovaries may be preserved in young patients with tumors confined to the uterus [2,11,12]. Intraperitoneal morcellation of uLMS is associated with poorer prognosis; endoscopic supracervical hysterectomy or tumor enucleation and morcellation should be avoided [13,14]. The incidence of pelvic and para-aortic lymph-node metastasis is low; if metastases are palpable, hematogeneous metastasis is likely so that widespread that lymphonodeectomy will not improve the prognosis and is not advisable [15].…”

Section: Surgical Therapymentioning

confidence: 99%

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Uterine Leiomyosarcoma

et al. 2018

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Uterine leiomyosarcoma (uLMS) is a rare entity among malignant gynecologic tumors with a very unfavorable prognosis and the highest prevalence in the pre- and peri-menopause. Only early-stage tumors have an acceptable prognosis, provided the patient has been treated without injuring the uterus. uLMS is often diagnosed accidentally and the correct diagnosis ishampered by equivocal features similar to the far more frequent benign uterine fibroids. Surgery is the basis of therapy, and it should be done in order to remove the uterus intact. As vaginal, abdominal, and endoscopic surgery - possibly including morcellation - are the methods of choice for the treatment of uterine fibroids, pre-operatively undiagnosed leiomyosarcoma detected by pathologic examination will have a worsened prognosis. Systemic treatment and radiotherapy are of no proven value in the adjuvant setting. Thus, there is strong need for a reliable pre-operative risk score for leiomyosarcoma in order to justify diagnostic means beyond clinical routine and to choose the correct surgical pathway. The clinical problems in the diagnosis of leiomyosarcoma and treatment are exemplified by a case report of a 30-year-old childless patient. Diagnostic tools as well as treatment options in adjuvant and palliative situations are reviewed.

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Section: Surgical Therapymentioning

confidence: 99%

“…Additional prognostic factors under discussion are free margins, mitotic score, and vessel invasion [18]. Morcellation truly contributes to grave prognosis [14]. As pulmonal metastasis is common, a thoracic X-ray image or CT-scan should be considered.…”

Section: Prognosismentioning

confidence: 99%

Uterine Leiomyosarcoma

et al. 2018

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“…Another unfavorable factor that has been discussed is uterine morcellation [12,13,14]. The relevance of mitotic rate, evidence of p53, and tumor necrosis is unclear [7,11,15,16].…”

Section: Introductionmentioning

confidence: 99%

Low-Grade Endometrial Stromal Sarcoma - a Review

Thiel¹,

Halmen²

2018

Oncol Res Treat

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Like other uterine sarcomas, low-grade endometrial stromal sarcomas (LG-ESS) are a very rare tumor entity. In the past, research studies therefore discussed the various different types of the disease in combination. In addition, the classification of endometrial stromal tumors presented difficulties for quite some time so that in earlier studies it was not always possible to precisely distinguish between LG-ESS, high-grade endometrial stromal sarcoma, and undifferentiated uterine sarcoma. For LG-ESS, surgery with hysterectomy and adnexectomy is the first-line treatment. The benefits of lymphadenectomy and tumor debulking are unclear. Endocrine therapy with gestagens and aromatase inhibitors is under discussion to provide adjuvant treatment for patients with advanced stages of the disease. As radiotherapy only provides locoregional control, and in view of the usually good prognosis of patients with LG-ESS, its benefits need to be weighed against its side effects. In the case of recurrence, repeat surgery is the first choice. Further research studies viewing LG-ESS as a distinct entity are needed in order to improve treatment options for patients with LG-ESS.

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“…When seeding, this may lead to benign conditions such as so-called parasitic leiomyoma or peritoneal adenomyosis [7][8][9][10][11], but may also result in peritoneal dissemination of inadvertently morcellated malignancy, e.g., uterine sarcoma mistaken for benign leiomyoma [11][12][13]. Despite controversial discussion [14], evidence suggests that the prognosis of malignant disease may thus be worsened iatrogenically [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%