Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, United States; Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard School of Medicine, Boston, MA, United States.
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard School of Medicine, Boston, MA, United States.
Gynecol Oncol. 2014 Feb;132(2):360-5. doi: 10.1016/j.ygyno.2013.11.024. Epub 2013 Dec 1.
To describe the role of immediate re-exploration in patients with inadvertently morcellated uterine leiomyosarcoma (ULMS) and smooth muscle tumors of uncertain malignant potential (STUMP).
All patients with ULMS/STUMP who were managed or referred to the participating institutions from January 2005 to January 2012 following minimally invasive gynecology surgery with morcellation were detected through the pathology database. The diagnosis was confirmed by gynecologic-pathologists following post-surgery pathology review.
Twenty-one patients with the diagnosis of ULMS (N = 15) and STUMP (N = 6) after morcellation were identified. The median age of occurrence was 46 years (range, 25-58 years). Median follow-up duration was 27 months (range, 1.8-93.1 months). None of the 21 patients had documented evidence of extra-uterine disease at the time of original surgery. Ultimately 12 patients were immediately re-explored to complete staging. The median time to the staging surgery was 33 days (range 15-118 days). Two (28.5%) out of seven patients with presumed stage I ULMS and one (25%) out of four patients with presumed stage I STUMP had significant findings of disseminated intraperitoneal disease detected at immediate surgical re-exploration. One of the 8 patients with confined early ULMS and STUMP at the second surgery had intraperitoneal recurrence, while the remaining 7 patients have had no recurrence and remain disease free.
Surgical re-exploration is likely to show findings of disseminated peritoneal sarcomatosis in a significant number of patients diagnosed with ULMS after a morcellation procedure. Findings from re-exploration can contribute to the knowledge of natural history of morcellated ULMS/STUMP and allow for accurate prognostication.
描述在无意中进行了子宫平滑肌肉瘤（ULMS）和平滑肌肿瘤恶性潜能不确定（STUMP）旋切术的患者中进行即刻再次探查的作用。
通过病理数据库，检测了所有 2005 年 1 月至 2012 年 1 月间在微创妇科手术后进行旋切术、并由参与机构管理或转诊的 ULMS/STUMP 患者。通过术后病理检查，由妇科病理学家确认诊断。
发现 21 例 ULMS（N=15）和 STUMP（N=6）患者在旋切术后被诊断为该疾病。发病中位年龄为 46 岁（范围，25-58 岁）。中位随访时间为 27 个月（范围，1.8-93.1 个月）。最初手术时，没有 21 例患者有记录在案的子宫外疾病证据。最终 12 例患者立即进行了再次探查以完成分期。分期手术的中位时间为 33 天（范围 15-118 天）。7 例假定为 I 期 ULMS 中的 2 例（28.5%）和 4 例假定为 I 期 STUMP 中的 1 例（25%）患者在即刻手术再次探查时发现了弥漫性腹膜疾病的明显播散。8 例局限于早期 ULMS 和 STUMP 的患者中有 1 例在第二次手术时出现了腹膜内复发，而其余 7 例患者无复发且疾病未进展。
在进行了旋切术的 ULMS 患者中，大量患者再次探查时可能会发现弥漫性腹膜肉瘤病的表现。再次探查的结果有助于了解旋切 ULMS/STUMP 的自然史，并能进行准确的预后评估。
