Risk of incidental genital tract malignancies at the time of myomectomy and hysterectomy for benign conditions
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ObjectiveTo determine the incidence of accidentally diagnosed genital malignancies in women undergoing gynecologicalsurgeries for pathologies presumed to be benign. MethodsData of all women who underwent hysterectomy for benign indications were retrieved from hospital records. A totalof 628 cases of hysterectomy and 35 cases of myomectomy were included. The final histopathology was accessedthrough the computer records, and the total number of genital tract malignancies was included. ResultsThe incidence of occult uterine, ovarian, and cervical malignancies in women undergoing hysterectomy was 0.47%,0.31%, and 0.15%, respectively. The incidence of uterine corpus malignancies in women undergoing myomectomywas 2.8%, and 3 cases of smooth muscle tumor of uncertain malignant potential (STUMP) were also identified. Endometrial stromal sarcomas were the most common pathology among uterine malignancies, followed byleiomyosarcoma and endometrial adenocarcinoma. ConclusionPostoperative diagnosis of malignancies in women undergoing surgery for benign indications poses great challengesto the treating surgeon. Occult malignancies must be ruled out by thorough preoperative assessment, especially insome subsets of women. Morcellation is an inevitable technique and complement to laparoscopic surgeries, althoughlittle chances of malignancy spread is related to its use. Nevertheless, thorough preoperative investigations and alwaysensuring contained morcellation can minimize these chances.
Abstract
ObjectiveTo determine the incidence of accidentally diagnosed genital malignancies in women undergoing gynecologicalsurgeries for pathologies presumed to be benign. MethodsData of all women who underwent hysterectomy for benign indications were retrieved from hospital records. A totalof 628 cases of hysterectomy and 35 cases of myomectomy were included. The final histopathology was accessedthrough the computer records, and the total number of genital tract malignancies was included. ResultsThe incidence of occult uterine, ovarian, and cervical malignancies in women undergoing hysterectomy was 0.47%,0.31%, and 0.15%, respectively. The incidence of uterine corpus malignancies in women undergoing myomectomywas 2.8%, and 3 cases of smooth muscle tumor of uncertain malignant potential (STUMP) were also identified. Endometrial stromal sarcomas were the most common pathology among uterine malignancies, followed byleiomyosarcoma and endometrial adenocarcinoma. ConclusionPostoperative diagnosis of malignancies in women undergoing surgery for benign indications poses great challengesto the treating surgeon. Occult malignancies must be ruled out by thorough preoperative assessment, especially insome subsets of women. Morcellation is an inevitable technique and complement to laparoscopic surgeries, althoughlittle chances of malignancy spread is related to its use. Nevertheless, thorough preoperative investigations and alwaysensuring contained morcellation can minimize these chances.
참고문헌 (17)
- Cohen SL, "Updated hysterectomy surveillance and factors associated with minimally invasive hysterectomy", JSLS, 18, pp.e2014.0009~ (2014)
- Mahnert N, "Unexpected gynecologic malignancy diagnosed after hysterectomy performed for benign indications", Obstet Gynecol, 125, pp.397~405 (2015)
- Rivard C, "New challenges in detecting, grading, and staging endometrial cancer after uterine morcellation", J Minim Invasive Gynecol, 19, pp.313~316 (2012)
- Ramm O, "Utility of preoperative endometrial assessment in asymptomatic women undergoing hysterectomy for pelvic floor dysfunction", Int Urogynecol J Pelvic Floor Dysfunct, 23, pp.913~917 (2012)
- Pritts EA, "The prevalence of occult leiomyosarcoma at surgery for presumed uterine fibroids : a metaanalysis", Gynecol Surg, 12, pp.165~177 (2015)
- Hill AJ, "Unanticipated uterine pathologic finding after morcellation during robotic-assisted supracervical hysterectomy and cervicosacropexy for uterine prolapse", Female Pelvic Med Reconstr Surg, 20, pp.113~115 (2014)
- Liu FW, "A critical assessment of morcellation and its impact on gynecologic surgery and the limitations of the existing literature", Am J Obstet Gynecol, 212, pp.717~724 (2015)
- Desai VB, "Occult gynecologic cancer in women undergoing hysterectomy or myomectomy for benign indications", Obstet Gynecol, 131, pp.642~651 (2018)
- White MP, "Uterine smooth muscle tumors of uncertain malignant potential (STUMP): review of pathophysiology, classification, diagnosis, treatment, and surveillance", J Healthc Commun, 2, pp.40~ (2017)
- Hanifi Şahin, "Uterine smooth muscle tumor of uncertain malignant potential: fertility and clinical outcomes", Journal of Gynecologic Oncology, 30(4), pp.1~12 (2019), 대한부인종양학회[DOI]
- Gadducci A, "Uterine smooth muscle tumors of unknown malignant potential : a challenging question", Gynecol Oncol, 154, pp.631~637 (2019)
- Mowers EL, "Effects of morcellation of uterine smooth muscle tumor of uncertain malignant potential and endometrial stromal sarcoma : case series and recommendations for clinical practice", J Minim Invasive Gynecol, 22, pp.601~606 (2015)
- Ganesan R., "Uterine smooth muscle tumour of uncertain malignant potential (STUMP): where are we now?", Case Rep Womens Health, 26, pp.e00176~ (2020)
- Frick AC, "Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse", Am J Obstet Gynecol, 202, pp.507.e1~507.e4 (2010)
- Ackenbom MF, "Incidence of occult uterine pathology in women undergoing hysterectomy with pelvic organ prolapse repair", Female Pelvic Med Reconstr Surg, 22, pp.332~335 (2016)
- Rosendahl M, "Cryopreservation of ovarian tissue for fertility preservation : no evidence of malignant cell contamination in ovarian tissue from patients with breast cancer", Fertil Steril, 95, pp.2158~2161 (2011)