Unsuspected Diagnosis of Uterine Leiomyosarcoma after Laparoscopic Myomectomy

Study Objective: To evaluate the risk of peritoneal dissemination after laparoscopic myomectomy and morcellment for unsuspected sarcoma. Design: Retrospective analysis of three consecutive cases of uterine leiomyosarcoma. Setting: University-affiliated hospital. Patients: Between January 2000 and December 2008, 588 patients had laparoscopic myomectomy at the Department of Obstetrics and Gynecology, University of Bari, Italy and among these 3 cases (0.5%) of uterine leiomyosarcoma were diagnosed at pathologic examination. Intervention: Following diagnosis of malignant condition all patients were extensively staged with pelvic examination, transvaginal ultrasound, hysteroscopy, Pap smear and total-body CT scan that did not revealed any sign of persistent disease. Within 28 days from primary surgery all patients, after informed consent, were submitted to a surgical staging including total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, resection of all trocar ports, pelvic lymphadenectomy and peritoneal washings. Measurements and Main Results: Pathologic examination did not revealed persistent tumor in the uterus, and no sign of peritoneal disease (negative cytology, adnexae and nodes). Conclusion: Uterine sarcomas are rare tumors, ultrasound and clinical findings are similar to their benign counterpart (uterine fibroids) and diagnosis is almost always made after pathologic examination. With the wide development of endoscopic procedures for surgical treatment of uterine fibroids the management of an unsuspected sarcoma after laparoscopy will be more common in the future. However, based on the reported cases no increased risk of dissemination within the abdominal cavity can be anticipated. This condition raises the question wheather laparoscopic procedure (gas insufflation and morcellment) may increase the risk of tumor dissemination within the abdominal cavity.