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Parasitic Fibroids
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Another popular theory for the development of parasitic fibroids is unconfined morcellation during gynecological surgeries and can be seen in about 1% of cases [8]. The first case of a parasitic fibroids after use of the laparoscopic morcellation was reported in 1997 by Ostrzenski [9]. In fact, the prevalence of uterine sarcoma and morcellation has been the focus of most discussions in recent times. However, benign sequelae are much more common than the presence of sarcoma in the morcellated tissues. The US Food and Drug Administration quoted the presence of sarcoma in fibroids that are surgically removed to be 1 in 350 cases in 2014 [10]. However, a meta-analysis by Pritts et al. [11] reported a much lower incidence (1 in 2000). Though not as sinister as sarcoma, benign sequelae are more common and may need another surgical intervention following the initial surgery where morcellation was used. These are seen more with unconfined morcellation with electromechanical device, which was the norm until recent times. A systematic review by Van der Meulen (2016) included 44 studies and reported that the incidence of iatrogenic parasitic fibroids was 0.12–0.94% [12]. The total number of patients included was 69, and the time of presentation from the primary surgery was an average of 4 years. The mean number of parasitic fibroids was 2.9 (range of 1–16), most frequently seen after myomectomy; 21.7% of patients were asymptomatic in this review. Most patients with parasitic fibroids present with abdominal discomfort, fatigue, backache, dyspareunia, and urinary/bowel complaints [12].
Uterine Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Claudia von Arx, Hani Gabra, Christina Fotopoulou
Malignant uterine epithelial tumors and uterine sarcoma have different clinicopathological and molecular features that require a different management. In this chapter, we focus on epithelial tumor types, including endometrioid adenocarcinoma (80–90%), serous carcinoma, clear cell carcinoma, undifferentiated/dedifferentiated carcinoma, and carcinosarcoma.
Uterine Leiomyosarcoma
Published in John C. Petrozza, Uterine Fibroids, 2020
Roni Nitecki, J. Alejandro Rauh-Hain
Mesenchymal tumors are comprised of uterine sarcomas (leiomyosarcomas and endometrial stromal sarcoma) and mixed epithelial/stromal tumors (carcinosarcomas and adenosarcomas) [1]. While rare, the rate of uterine sarcoma diagnosis appears to be increasing; from 1988 to 2001, their incidence rose from 7.6% to 9.1% of all uterine cancers [2]. The most common type of uterine sarcoma is uterine leiomyosarcoma (ULMS). The annual incidence of ULMS is 0.64 per 100,000 women [3] and represents only 1%–2% of uterine malignancies [1]. The median age at diagnosis is 55 years old [2]. These tumors are large myometrial masses, which typically spread hematogenously. The diagnosis is challenging because patients present with vague symptoms similar to those of patients with uterine leiomyomas. ULMSs are notorious for their aggressive nature; several studies support survival rates near 50% for stage I–II disease and 0%–28% for stage III–IV disease [4–5]. Prior studies have identified prognostic factors at the time of primary diagnosis, such as stage and mitotic count. Other factors, such as age, tumor size and tumor grade, have all similarly been investigated, but there is no clear association that has been replicable and statistically significant [2–6].
Introduction to a special issue of the International Journal of Hyperthermia: “the status and prospects of the clinical applications of high intensity focused ultrasound”
Published in International Journal of Hyperthermia, 2021
Another commonly-debated topic around HIFU treatment of uterine fibroids is post-treatment pathological diagnosis. Since HIFU is a noninvasive procedure, a pathological diagnosis cannot be made. It is important to determine how we can prevent mistaking a uterine sarcoma for a uterine fibroid. Does misdiagnosis and treatment of a lesion thought to be a uterine fibroid with HIFU lead to disastrous results? Wang et al. performed a retrospective study with a total of 15,759 patients, taking a decade of HIFU treatments into consideration [15]. The study examined records from 10 hospitals dating from 2008 to 2019 and found that pre-operative MRI plays an important role in distinguishing sarcomas from fibroids. Even if a misdiagnosis occurred, however, treating sarcoma patients with HIFU did not lead to worse outcomes compared to patients who were found to have a sarcoma and underwent open surgery.
Ectopic leiomyoma as a late complication of laparoscopic hysterectomy with power morcellation: a case report and review of the literature
Published in Acta Chirurgica Belgica, 2020
Karel Dewulf, Valerie Weyns, Bart Lelie, Hussain Qasim, Joke Meersschaert, Bart Devos
Since the case of a physician undergoing morcellation of an unrecognized sarcoma with subsequent spread of the sarcoma in the abdominal cavity [5], the most debated complication is the risk of spreading occult malignancy. In 2014, the US Food and Drug Administration (FDA) published a safety recommendation discouraging the use of power morcellators as one in 350 woman undergoing hysterectomy for the treatment of fibroids harvest uterine sarcoma. If a power morcellator is used, morcellation should take place in a specimen bag [6]. The FDA currently estimates the risk of a hidden uterine sarcoma between one in 225 and one in 580 women and the presence of a leiomyosarcoma (LMS) between one in 495 and one in 1100 women undergoing surgery for uterine fibroids. Therefore, the FDA still warns against the use of laparoscopic power morcellators in the majority of women undergoing myomectomy or hysterectomy for uterine fibroids [7]. However, many leading gynecologic surgeons criticize the numbers used by the FDA as non-peer reviewed articles and retrospective studies were included. Using high quality research, they conclude that the prevalence of occult LMS is lower, between one in 1150 and one in 8720 [8].
Two-stage surgery for extra pelvic intravenous leiomyomatosis: report of a case
Published in Journal of Obstetrics and Gynaecology, 2020
Denizhan Bayramoglu, Atilla Orhan, Ayhan Gul, Gozde Sahin, Zeliha Esin Celik, Mustafa Koplay, Cetin Celik
A 42-year-old multiparous, premenopausal woman applied Selcuk University Obstetrics and Gynecology clinic with complaints of menometrorrhagia and pelvic pain. On physical examination, a palpable mass with a moderate hardness, extending to the right upper quadrant from the lower midline of abdomen was observed. The tumour markers, haemograms and biochemical markers were normal. In ultrasonography (USG), numerous masses were observed, in which the largest – about 7 cm size – contained heterogeneous structures with multiple cystic occurrences. It could not be clearly distinguished as degenerative myomas or sarcomas. A heterogeneous mass was observed using computer tomography (CT). The mass had a total size of approximately 15 ×10 cm, and adjacent intestinal structures that could not be clearly separated from the ovaries or uterus and hypodense areas in favour of the thrombus in IVC (Figure 1(A,B)). Probe curettage was reported as secretory endometrium. An operation planned with the pre-diagnosis of a uterine sarcoma.