Ehdaivand Shahrzad, Simon Rochelle A, Sung C James, Steinhoff Margaret M, Lawrence W Dwayne, Quddus M Ruhul
Department of Pathology of Alpert Medical School of Brown University/Women & Infants Hospital, Providence, RI 02905; Departments of Pathology of Emory University School of Medicine, Atlanta, GA 30322.
Department of Pathology of Alpert Medical School of Brown University/Women & Infants Hospital, Providence, RI 02905.
Hum Pathol. 2014 Nov;45(11):2311-7. doi: 10.1016/j.humpath.2014.07.018. Epub 2014 Aug 16.
Laparoscopic hysterectomy with morcellation (LHM) is considered a safe and less invasive alternative to other hysterectomy techniques by shortening postoperative hospital stay and patient recovery. Sparse incidental gynecologic neoplasms after LHM have been reported; however, the frequency and subsequent follow-up have not been systematically investigated in a large case series. We aimed to determine the frequency and types of incidental findings after LHM with clinical outcomes. An electronic chart review was conducted searching all cases of LHM performed within 5 years to determine the incidence of unexpected gynecologic neoplasms and subsequent peritoneal disease. Patient demographics, prior preoperative investigation, and subsequent follow-up were investigated. For comparison, the overall frequency of pertinent uterine neoplasms was noted during the study period. Of the 352 cases of LHM identified, 3 harbored unsuspected malignancies, an incidence of 0.9%. Four variant smooth muscle tumors (1.1%) and 5 benign non-smooth muscle neoplasms (1.4%) were identified at the time of initial morcellation. Two cases of subsequent peritoneal "implanted" leiomyoma were identified (0.6%). Of malignant or atypical mesenchymal neoplasms diagnosed at our institution during the study period, 8.6% were diagnosed in a morcellated specimen. There is a clinically important risk of occult malignant or atypical neoplasms in morcellated uterine specimens. Proper pathologic evaluation of malignant or atypical uterine neoplasms is limited when a uterus is morcellated. Patients undergoing morcellation procedures are also potentially at risk for dissemination of disease. Clinicians and patients should be aware of these risks when discussing surgical options for hysterectomy.
腹腔镜下子宫切除术伴粉碎术（LHM）通过缩短术后住院时间和患者康复时间，被认为是一种比其他子宫切除技术更安全、侵入性更小的替代方法。已有报道称LHM术后偶发妇科肿瘤；然而，在一个大型病例系列中，其发生率及后续随访情况尚未得到系统研究。我们旨在确定LHM术后偶发情况的发生率和类型及其临床结局。我们进行了一项电子病历回顾，搜索了5年内所有LHM病例，以确定意外妇科肿瘤及后续腹膜疾病的发生率。对患者的人口统计学资料、术前检查及后续随访情况进行了调查。为作比较，我们记录了研究期间相关子宫肿瘤的总体发生率。在352例已确认的LHM病例中，有3例存在未被怀疑的恶性肿瘤，发生率为0.9%。在初次粉碎术时发现了4例变异型平滑肌瘤（1.1%）和5例良性非平滑肌肿瘤（1.4%）。发现2例后续腹膜“植入性”平滑肌瘤（0.6%）。在研究期间，在我们机构诊断的恶性或非典型间叶性肿瘤中，8.6%是在粉碎标本中诊断出来的。在粉碎的子宫标本中存在隐匿性恶性或非典型肿瘤的重要临床风险。当子宫被粉碎时，对恶性或非典型子宫肿瘤进行适当的病理评估会受到限制。接受粉碎术的患者也有疾病播散的潜在风险。临床医生和患者在讨论子宫切除手术方案时应了解这些风险。
