The Impact of Tumor Morcellation During Surgery on the Outcomes of Patients with Apparently Early Low-Grade Endometrial Stromal Sarcoma of the Uterus

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

doi:10.1245/s10434-011-1751-y

Cited by 88 publications

(75 citation statements)

References 35 publications

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“…23 Indeed, the incidence of uterine sarcoma is rare, and leiomyosarcoma accounts for only 30% of all uterine sarcomas. 10 In 2009, Park et al 10,11 found that tumor morcellation was associated with higher abdominopelvic recurrence and decreased disease-free survival for both leiomyosarcoma and endometrial stromal sarcoma but only with decreased survival for leiomyosarcoma. In our study, there were 6 patients who underwent morcellation and who were subsequently diagnosed with uterine sarcoma, either immediately or several years later.…”

Section: Ajogorgmentioning

confidence: 99%

“…8,9 There are no specific symptoms or signs or reliable diagnostic modalities to differentiate benign from malignant uterine tumors before they are morcellated and removed. 10,11 Parasitic myomas are defined as leiomyomas that are not attached to the uterus and are "parasitic" because they receive their blood supply from surrounding organs. 12 They have a reported incidence of 0.12-0.9% after laparoscopic surgery with power morcellation.…”

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confidence: 99%

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Uterine sarcomas and parasitic myomas after laparoscopic hysterectomy with power morcellation

Tan-Kim

Hartzell

Reinsch

et al. 2015

American Journal of Obstetrics and Gynecology

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Section: Ajogorgmentioning

confidence: 99%

mentioning

confidence: 99%

Uterine sarcomas and parasitic myomas after laparoscopic hysterectomy with power morcellation

Tan-Kim

Hartzell

Reinsch

et al. 2015

American Journal of Obstetrics and Gynecology

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“…About 25% to 75% of patients with early ESS have recurrence in the pelvis and abdomen. These recurrences may be caused by inadvertent tumor morcellation during surgery [57]. Park et al [58] found that inadvertent tumor morcellation during surgery had adverse effects on the disease-free survival of patients with early ESS.…”

Section: Primary Surgerymentioning

confidence: 99%

Diagnosis and treatment of sarcoma of the uterus. A review

2012

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Background. The histopathological classifi cation and staging system for uterine sarcoma (US) were revised in 2003 and 2009, respectively. However, there is currently no consensus on the signifi cance of various prognostic factors. Therefore the available clinicopathological data on US are summarized in this review. Methods. Articles on uterine sarcoma published in English from 1970 to 2011 were identifi ed systematically by computer-based searches in Medline and the Cochrane Library. Results. Prognosis of US is poor, with a fi ve-year survival rate as low as 30%. The most common histological types are leiomyosarcoma (LMS, 63%), endometrial stromal sarcoma (ESS, 21%), adenosarcoma (6%), undifferentiated sarcoma (5%) and other types (5%). Carcinosarcoma is a mixed tumor, which is today regarded as a subset of endometrial carcinoma. Disease stage is the most important prognostic factor for all types of US. However, the prognosis of stage I LMS is also signifi cantly related to tumor size and mitotic index (MI), and stage I ESS is related to MI and tumor cell necrosis (TCN). In adenosarcoma, TCN is the only signifi cant histopathological prognostic factor. Information on the use of preoperative imaging for staging purposes is lacking. Total hysterectomy is the cornerstone of US treatment. The ovary can be preserved in premenopausal women with early-stage LMS and ESS, and routine lymphadenectomy is not necessary unless enlarged lymph nodes are present. As tumor-free resection margins at primary surgery are the most important prognostic factor for survival, sarcoma surgery should be centralized. Adjuvant treatment has changed from radiation therapy to chemotherapy over the last decades, without any change in survival. Conclusion . There are differences in survival between histological types of US. LMS and ESS can be divided into different prognostic groups and should be treated separately. Uterine sarcomas are rare neoplasms of mesenchymal origin. According to the World Health Organization (WHO) 2003 classifi cation, they consist of two main groups: mesenchymal tumors and mixed epithelial and mesenchymal tumors [1]. The pure mesenchymal tumors can be further classifi ed into endometrial stromal sarcoma (ESS), leiomyosarcoma (LMS) -including the epithelioid and myxoid variants -and undifferentiated endometrial/uterine sarcoma (UUS) according to the cell of origin.

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“…Morcellation of unsuspected uterine sarcomas can be associated with spread of disease and decreased survival rates [9][10][11]. The same is true for variants of leiomyomas such as cellular leiomyoma, atypical leiomyoma, and smooth muscle tumors of undetermined malignant potential [12].The definitive diagnosis of these lesions is provided via histology.…”

Section: Discussionmentioning

confidence: 99%

Biopsy of Uterine Leiomyomata and Frozen Sections Before Laparoscopic Morcellation

Tulandi

Ferenczy

2014

Journal of Minimally Invasive Gynecology

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The Impact of Tumor Morcellation During Surgery on the Outcomes of Patients with Apparently Early Low-Grade Endometrial Stromal Sarcoma of the Uterus

Abstract: Inadvertent tumor morcellation during surgery has an adverse impact on the outcomes of patients with early LGESS.

Cited by 88 publications

References 35 publications

Uterine sarcomas and parasitic myomas after laparoscopic hysterectomy with power morcellation

Uterine sarcomas and parasitic myomas after laparoscopic hysterectomy with power morcellation

Diagnosis and treatment of sarcoma of the uterus. A review

Biopsy of Uterine Leiomyomata and Frozen Sections Before Laparoscopic Morcellation

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