Keywords
uterine leiomyoma
laparoscopic morcellation
hidden leiomyosarcoma
leiomyosarcoma recurrences
How to Cite
Abstract
Uterine sarcomas are a heterogeneous group of rare, highly malignant mesenchymal tumors that account for 3–7% of uterine tumors. mostly developing after the age of 40 and the average age is 60 years. Due to the rarity and high heterogeneity, the international agreement of this early clinical diagnosis has not been achieved. Differential diagnosis of these two diseases is difficult before surgery and requires postoperative histopathological examination of the material.
Due to shorter postoperative rehabilitation time and lower risk of infection, some clinicians over open surgery prefer laparoscopic myomectomy or hysterectomy with morcellation, which allows us to cut the uterus and remove it through a small laparoscopic channel. In patients with a diagnosis of leiomyoma who in reallity have uterine sarcoma, the use of laparoscopic morcellation is associated with the risk of spread and implantation of tumor tissue in the peritoneum, and therefore with a decrease in the patient's life expectancy.
The patient underwent laparoscopic hysterectomy with morcellation in 2014 at the age of 60 due to symptomatic myoma. Postoperative histological examination revealed typical uterine leiomyoma in all examined specimens. Two years later, the patient referred to the clinic due to an increase in the size of the abdomen.
During the examination, non-organ volumetric formations in the abdominal cavity were determined, with dimensions of 12x13x8cm and 3.5x2cm and 4x3cm. In the removed nodules, leiomyosarcoma with G1 differentiation degree was histologically diagnosed. In 2018, 2019, 2020, 2022 there were recurrences of various sizes in the small pelvis and iliac fossa. The size and location of the nodules varied, but each was highly differentiated -grade G1.
The current preoperative diagnostic methods do not allow us to differentiate between leiomyosarcoma and leiomyoma, so it is important to focus on the signs of malignancy when planning the treatment method, to take into account the recommendations provided by the FDA and such atypical cases as hidden leiomyosarcoma. This is confirmed by the negative result shown in this clinical case.
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