Prevalence of Occult Leiomyosarcomas and Atypical Leiomyomas After Laparoscopic Morcellation of Leiomyomas in Reproductive-Age Women

摘要

Uterine tumors are a public health issue because of their prevalence in women and their connection to menstrual disorders, anemia, pelvis pain, pregnancy loss, and infertility. Treatment of symptomatic fibroids includes open myomectomy or hysterectomy, which have higher morbidity rates, longer hospital stays, and more disruption of daily life. This study looks at the prevalence of leiomyosarcomas in women who underwent laparoscopic myomectomies for benign tumors. In 2014, the US Food and Drug Administration (FDA) released a warning against the use of laparoscopic power morcellators to remove benign uterine fibroids because of the risk of spreading unknown sarcomas and increasing the mortality risk of the patients. The FDAwarning was based on a review of published studies that revealed 1 case of unsuspected uterine sarcoma and 1 of unsuspected leiomyosarcoma in women undergoing hysterectomy or myomectomy for benign leiomyoma. While usually affecting older women, there are limited data on the prevalence of sarcomas among reproductiveage women considering surgery for benign uterine tumors. The study data are from a Greek gynecological hospital between 2003 and 2015. Surgical specimens were inspected for the presence of leiomyomas or sarcomas. Patients included in the study reported growth of a uterine leiomyoma, distortion of the uterine cavity, a history of uterine shape-related pregnancy problems, or chronic pelvic pain. All patients had a preoperative diagnosis of a benign leiomyoma. Specimen slides were examined by an experienced pathologist who identified benign and atypical leiomyomas. Patients receiving a laparoscopic myomectomy had experienced menstrual bleeding (73.3%), rapid leiomyomas growth (10.8%), infertility (2.05%), and chronic pelvic pain (0.3%). In the specimens studied, no leiomyosarcomas were found in the 2582 myomas removed. There were 34 cases identified as adenomyomas, 45 as leiomyomas with infarcts, 81 as cellular myomas, and 133 cases as degenerated. The study notes that because of the lack of clear diagnostic criteria distinguishing between benign leiomyomas and sarcomas, the FDAwarning caused 57.8% of gynecologists in an Italian survey to change their surgical approach out of legal concerns. It recommends that all patients diagnosed as having benign leiomyomas should also be assumed to have a potential risk of uterine sarcoma. It also notes that other studies of patients with benign leiomyomas reported much lower rates of occult leiomyosarcomas. These rates are much lower than the data that drove he FDA warning. Possible reasons for this discrepancy in results are discussed, but the rarity of uterine sarcomas results in poor- quality statistical data. It notes the benefits of endoscopic surgery for women of reproductive age and recommended the use of power morcellators should not be abandoned.