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Complete remission achieved by oophorectomy for recurrent endometrial stromal sarcoma after laparoscopic morcellation


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.

Endometrial Stromal Sarcoma Diagnosed after Uterine Morcellation in Laparoscopic Supracervical Hysterectomy

Endometrial stromal sarcoma is a rare uterine cancer with no reliable method for preoperative diagnosis. A 30–year–old parous woman underwent laparoscopic supracervical hysterectomy because of a leiomyoma. The uterus was removed from the abdominal cavity with an electric morcellator with a spinning blade. The pathology report revealed low–grade endometrial stromal sarcoma. Two months after the initial surgery, a second laparoscopic procedure was performed. The final pathology report confirmed low–grade endometrial stromal sarcoma involving the ovary, fallopian tube, and ovarian artery. It was concluded that morcellation of leiomyomas at laparoscopic supracervical hysterectomy may potentially increase metastasis if the tumor is a sarcoma.

Link to abstract:

Technical update on tissue morcellation during gynaecologic surgery


MIS has proven benefits for patients and likely for society as a whole. Tissue morcellation including the use of power morcellators is often required to facilitate a less invasive surgical approach. However, there are risks with removing tissue through these techniques that include dissemination of undiagnosed malignancy and injury to adjacent organs and/or vasculature.