Incidentally Morcellated High grade LeiomyosarcomaTreated by Cytoreductive Surgery and simultaneous Hyperthermic Intraperitoneal Chemotherapy

Abstract

The incidental morcellation of uterinesarcomas during laparoscopicmanagement of uterine tumors preoperatively misdiagnosed as benignfibroids constitutes a clinical challenge for the further oncologicaltreatment and results in an iatrogenic tumor upstaging. Tumor celldissemination in the abdominal cavity with the risk of a compromisedoncologic outcome, constitutes a major clinical challenge in affectedpatients. In this report we present the case of a 49 year old patient, forwhom a uterine morcellation was conducted as part of a endoscopicsupracervical hysterectomy for the preoperative diagnosis of a symp-tomatic fibroid of the uterus. Postoperatively, final histopathologicexam revealed the presence of a high grade leiomyosarcoma in theuterine specimen. Further oncologic surgical treatment consisted of amedian exploratory laparotomy with cytoreductive surgery (CRS) andan hyperthermic intraperitoneal chemotherapy (HIPEC). The postoper-ative course of the patient proved uneventful. HIPEC may complementCRS in patients with incidental uterine sarcoma morcellation. In ourcase, HIPEC was well tolerated and no tumor relapse was observed afterthree, six and twelve months postoperatively. Further studies are neededin order to evaluate the potential benefit of HIPEC in the oncologictreatment of patients with incidental morcellation of uterine sarcoma