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Updated: May 16, 2026
Quantitation of Intra-peritoneal Ovarian Cancer Metastasis
Published on: July 18, 2016
Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms
Michael A Seidman1, Titilope Oduyebo, Michael G Muto
1Division of Women's and Perinatal Pathology, Department of Pathology, Brigham & Women's Hospital/Harvard Medical School, Boston, Massachussetts, United States of America. mseidman@partners.org
Background:
Power morcellation has become a common technique for the minimally invasive resection of uterine leiomyomas. This technique is associated with dissemination of cellular material throughout the peritoneum. When morcellated uterine tumors are unexpectedly found to be leiomyosarcomas or tumors with atypical features (atypical leiomyoma, smooth muscle tumor of uncertain malignant potential), there may be significant clinical consequences. This study was undertaken to determine the frequency and clinical consequence of intraperitoneal dissemination of these neoplasms.
Methodology/Principal Findings:
From 2005-2010, 1091 instances of uterine morcellation were identified at BWH. Unexpected diagnoses of leiomyoma variants or atypical and malignant smooth muscle tumors occurred in 1.2% of cases using power morcellation for uterine masses clinically presumed to be "fibroids" over this period, including one endometrial stromal sarcoma (ESS), one cellular leiomyoma (CL), six atypical leiomyomas (AL), three smooth muscle tumor of uncertain malignant potential (STUMPs), and one leiomyosarcoma (LMS). The rate of unexpected sarcoma after the laparoscopic morcellation procedure was 0.09%, 9-fold higher than the rate currently quoted to patients during pre-procedure briefing, and this rate may increase over time as diagnostically challenging or under-sampled tumors manifest their biological potential. Furthermore, when examining follow-up laparoscopies, both from in-house and consultation cases, disseminated disease occurred in 64.3% of all tumors (zero of one ESS, one of one CL, zero of one AL, four of four STUMPs, and four of seven LMS). Only disseminated leiomyosarcoma, however, was associated with mortality. Procedures are proposed for pathologic evaluation of morcellation specimens and associated follow-up specimens.
Conclusions/Significance:
While additional study is warranted, these data suggest uterine morcellation carries a risk of disseminating unexpected malignancy with apparent associated increase in mortality much higher than appreciated currently.
Insights
Power morcellation for uterine fibroids risks spreading unexpected cancers. Disseminated leiomyosarcoma after morcellation is linked to increased mortality, a risk higher than currently disclosed.
Area of Science:
- Gynecologic Oncology
- Minimally Invasive Surgery
- Pathology
Background:
- Power morcellation is a common technique for uterine leiomyoma resection.
- The procedure can lead to the dissemination of cellular material within the peritoneum.
- Unexpected findings of leiomyosarcoma or other malignant/atypical tumors can have serious clinical consequences.
Purpose of the Study:
- To determine the frequency of intraperitoneal dissemination of unexpected neoplasms after uterine morcellation.
- To assess the clinical consequences of such dissemination.
Main Methods:
- Retrospective review of 1091 uterine morcellation cases from 2005-2010.
- Analysis of follow-up laparoscopies for disseminated disease.
- Pathologic evaluation of morcellation and follow-up specimens.
Main Results:
- 1.2% of cases revealed unexpected leiomyoma variants or malignant smooth muscle tumors.
- The rate of unexpected sarcoma was 0.09%, significantly higher than patient briefings.
- Disseminated disease occurred in 64.3% of all unexpected tumors, with leiomyosarcoma associated with mortality.
Conclusions:
- Uterine morcellation carries a risk of disseminating unexpected malignancies.
- The risk of dissemination and associated mortality appears higher than currently recognized.
- Proposed procedures for pathologic evaluation and follow-up are suggested.
