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Low-Grade Endometrial Stromal Sarcoma Diagnosed 8 Years After Hysterectomy With Morcellation
Awa Sanneh1, Tricia Murdock, Stephanie L Wethington
1Johns Hopkins University School of Medicine, the Division of Gynecologic Pathology, Department of Pathology, Johns Hopkins Medicine, and the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
Background:
Morcellation at the time of minimally invasive hysterectomy or myomectomy for presumed benign indications carries a risk of disseminating undiagnosed uterine malignancies.
Case:
A 57-year-old woman with a remote history of laparoscopic hysterectomy with morcellation of a cellular leiomyoma presented with a newly diagnosed complex pelvic mass. Owing to adherence of the mass to the rectum and numerous peritoneal tumor implants, a surgical cytoreductive procedure was performed. The pelvic mass, implants, and original hysterectomy specimen were histologically identical and consistent with low-grade endometrial stromal sarcoma. Owing to lack of tumor-myometrial interface on the original morcellated specimen, this malignant diagnosis was not made at the time of hysterectomy.
Conclusion:
Morcellation of the uterus can hinder an accurate pathologic diagnosis of uterine stromal neoplasms.
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