A case of recurrent smooth muscle tumor of uncertain malignant potential with abdominal dissemination after morcellation

Objective: Smooth muscle tumor of uncertain malignant potential (STUMP) shares some characteristics with sarcoma but does not meet the full diagnostic criteria. Morcellation is a technique used to extract surgical specimens through a small incision, thereby spreading unsuspected malignant cells. We report a case of STUMP that recurred postoperatively in the abdominal cavity. Case Report: Surgery was performed on a patient diagnosed with uterine leiomyoma, with the tumor morcellated transvaginally. Twelve months later, several abdominal tumors appeared. Pathological specimens were reevaluated, and STUMP was diagnosed. Many tumors in the abdominal cavity of the patient were removed surgically. The postoperative pathologic diagnosis was leiomyosarcoma. Conclusion: This case of unsuspected STUMP recurrence after transvaginal scalpel morcellation illustrates the risk of spillage of malignant cells. Surgeons and surgical pathologists must stay alert to the possibility of occult malignancy, and morcellated tissues should be carefully examined.

Leiomyoma; STUMP; Transvaginal scalpel morcellation; Laparoscopy; Total hysterectomy

[1] George S., Barysauskas C., Serrano C., Oduyebo T., Rauh-Hain J.A., Del Carmen M.G., et al.: “Retrospective cohort study evaluating the impact of intraperitoneal morcellation on outcomes of localized uterine leiomyosarcoma”. Cancer, 2014, 120, 3154.

[2] Bogani G., Cliby W.A., Aletti G.D.: “Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma: a systematic review and meta-analysis”. Gynecol. Oncol., 2015, 137, 167.

[3] Bell S.W., Kempson R.L., Hendrickson M.R.: “Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases”. Am. J. Surg. Pathol., 1994, 18, 535.

[4] Ip P.P., Tse K.Y., Tam K.F.: “Uterine smooth muscle tumors other than the ordinary leiomyomas and leiomyosarcomas: a review of selected variants with emphasis on recent advances and unusual morphology that may cause concern for malignancy”. Adv. Anat. Pathol., 2010, 17, 91.

[5] Graebe K., Garcia-Soto A., Aziz M., Valarezo V., Heller P.B., Tch- abo N., et al.: “Incidental power morcellation of malignancy: A retrospective cohort study”. Gynecol. Oncol., 2015, 136, 274.

[6] US Food and Drug Administration (FDA), Obstetrics and Gynecology Devisory Committee. “FDA executive summary: Laparoscopic power morcellation during uterine surgery for fibroids, Washington, DC 2014”. Available at: http://www.fda.gov/advisorycommittees/ calendar/ucm400221.htm

[7] Jashnani K.D., Baviskar R.R.: “The surgical pathologist and laparoscopic gynecologic surgeries”. Indian J. Pathol. Microbiol., 2010, 53, 634.

[8] Cohen S.L., Einarsson J.I., Wang K.C., Brown D., Boruta D., Scheib S.A., et al.: “Contained power morcellation within an insufflated isolation bag”. Obstet. Gynecol., 2014, 124, 491.

[9] Aoki Y., Matsuura M., Matsuno T., Yamamoto T.: “Single-site inbag morcellation achieved via direct puncture of the pneumoperitoneum cap, a cordless electric morcellator, and a 5-mm flexible scope”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2016, 201, 126.