Incidental gynecologic neoplasms in morcellated uterine specimens: a case series with follow-up
Incidental gynecologic neoplasms in morcellated uterine specimens: a case series with follow-up
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DOI：
10.1016/j.humpath.2014.07.018
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发表时间：
2014-11-01
期刊：
影响因子：
3.3
通讯作者：
Quddus, M. Ruhul
中科院分区：
文献类型：
--
作者：
Ehdaivand, Shahrzad;Simon, Rochelle A.;Quddus, M. Ruhul
腹腔镜分块子宫切除术（LHM）被认为是一种安全且侵入性较小的替代子宫切除术技术，缩短了术后住院时间和患者恢复时间。LHM后稀疏的偶发妇科肿瘤已有报道；然而，在一个大的病例系列中，还没有系统地调查这种频率和随后的随访。我们的目的是确定LHM术后偶然发现的频率和类型以及临床结果。我们对所有5年内行LHM的病例进行电子病历回顾，以确定意外妇科肿瘤和随后腹膜疾病的发生率。调查了患者的人口统计学特征、术前调查和随后的随访。为了比较，在研究期间记录了相关子宫肿瘤的总体频率。在352例确诊的LHM中，3例有未被怀疑的恶性肿瘤，发病率为0.9%。在初始分块时发现4例变异平滑肌肿瘤（1.1%）和5例良性非平滑肌肿瘤（1.4%）。发现2例腹膜“植入性”平滑肌瘤（0.6%）。研究期间在我院诊断的恶性或非典型间充质肿瘤中，有8.6%是在碎粒标本中诊断出来的。有一个重要的临床风险隐匿恶性或非典型肿瘤的分块子宫标本。当子宫碎裂时，对恶性或非典型子宫肿瘤的病理评价是有限的。接受分块手术的患者也可能面临疾病传播的风险。临床医生和患者在讨论子宫切除术的手术选择时应该意识到这些风险。(C) 2014爱思唯尔公司版权所有。
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. (C) 2014 Elsevier Inc. All rights reserved.