Preoperative differentiation of endometrial stromal sarcoma (ESS) from myoma is challenged by the similarities in their clinical presentations and the unreliability of imaging studies. Often, ESS is diagnosed postoperatively after laparoscopic power morcellation of a presumed myoma (Amant et al., 2014 and Park et al., 2011). In approximately 80% of ESS cases diagnosed postoperatively after morcellation, preoperative diagnosis was either leiomyoma or adenomyosis (Park et al., 2011). Laparoscopic morcellation of ESS with an electromechanical morcellator can result in the dissemination of the tumor (Park et al., 2011 and Badia and Karini, 2010), but there has been no report of the spread of ESS after morcellation with a single incision on the uterus using a harmonic scalpel. Furthermore, if the ovaries are preserved at the time of the initial surgery, bilateral salpingo-oophorectomy (BSO) for recurrence is recommended (Amant et al., 2014 and Yoon et al., 2014), but the effect of BSO for recurrent ESS has not been reported. Here, we present a case where morcellation with a simple incision in total laparoscopic hysterectomy for a presumed myoma led to the peritoneal dissemination of ESS; and complete remission was achieved and laparoscopically confirmed after BSO for recurrent ESS.
Link to full article: http://www.sciencedirect.com/science/article/pii/S235257891400037X