Obstet Gynecol Sci.  2015 Sep;58(5):414-417. 10.5468/ogs.2015.58.5.414.

Intrapelvic dissemination of early low-grade endometrioid stromal sarcoma due to electronic morcellation

• Choo KJ
• Lee HJ
• Lee TS
• Kim JH
• Koh SB
• Choi YS

• KMID: 2058468
• DOI: http://doi.org/10.5468/ogs.2015.58.5.414

Abstract

Endometrioid stromal sarcoma is a rare malignancy that originates from mesenchymal cells. It is classified into low-grade endometrioid stromal sarcoma (LGESS) and high-grade endometrioid stromal sarcoma. Ultrasonographic findings of LGESS resemble those of submucosal myomas, leading to the possible preoperative misdiagnosis of LGESS as uterine leiomyoma. Electronic morcellation during laparoscopic surgery in women with LGESS can result in iatrogenic intraabdominal dissemination and a poorer prognosis. Here, we report a patient with LGESS who underwent a supracervical hysterectomy and electronic morcellation for a presumed myoma in another hospital. Disseminated metastatic lesions of LGESS in the posterior cul-de-sac and rectal serosal surface were absent on primary surgery, but found during reexploration. In conclusion, when LGESS is found incidentally following previous morcellation during laparoscopic surgery for presumed benign uterine disease, we highly recommend surgical reexploration, even when there is no evidence of a metastatic lesion in imaging studies.

Keyword

Endometrial stromal sarcoma; Leiomyoma; Morcellation; Uterus

MeSH Terms

Diagnostic Errors
Female
Humans
Hysterectomy
Laparoscopy
Leiomyoma
Myoma
Prognosis
Sarcoma*
Sarcoma, Endometrial Stromal
Uterine Diseases
Uterus

Figure

• 

  Fig. 1 The initial surgical findings of the rectal surface. The figure shows the abdominopelvic cavity after removal of the uterus by supracervical hysterectomy. There is no sign of metastasis in the rectal surface (arrow, rectal surface; arrowhead, remnant electrocauterized cervix).

• 

  Fig. 2 The resected rectum. (A) The gross finding of the resected rectum. The arrow indicates metastatic lesions of the rectal surface, which has an irregular surface contour. The arrowhead indicates the adjacent normal rectal serosa. (B) Low-power field microscopy shows a tumor (T) of the rectal surface, muscle layer (Ms) and mucosal layer (Mu) of the rectum (H&E stain, ×20). (C) H&E stain, ×400. (D) Immunohistochemical staining shows a positive indication of CD10 (×200).

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