Clinical Characteristics Differentiating Uterine Sarcoma and Fibroids.

BACKGROUND AND OBJECTIVES: Uterine fibroids are a common indication for laparoscopy. Unsuspected sarcoma can pose a serious risk if morcellation is used in the procedure. We sought to determine the clinical factors associated with uterine sarcoma compared with uterine fibroids. METHODS: We conducted a case-control study of 66 women who had hysterectomy for uterine sarcoma from April 1, 2007, to March 31, 2014. Sixty-six patients who had hysterectomy for fibroids were randomly selected as controls. RESULTS: Women with sarcoma vs women with fibroids, tended to be older (mean ± SD 62.1 ± 10.1 vs 46.5 ± 6.6; P < .0001), were more likely to be postmenopausal (81.8% vs 9.2%; P < .0001), and were more likely to have a history of another nonuterine malignancy (16.7% vs 4.6%; P = .02). Women with sarcoma were more likely to have masses that were subserosal (69.4% vs 34.8%; P < .0001), rather than intramural (11.1% vs 37.0%; P = .01), and to have a solitary rather than multiple uterine mass (56.3% vs 18.5%; P < .0001). They were also more likely to have a history of documented rapid growth (16.7% vs 4.6%; P = .02). CONCLUSION: Despite limitations in sample size related to infrequency of uterine sarcoma, our results suggest some preoperative clinical differences between women who have uterine sarcoma vs uterine fibroids. Further studies on such features may assist us in identifying patients who are at higher risk of having a uterine sarcoma among women with a uterine mass contemplating surgery.

Incidence of Tissue Morcellation During Surgery for Uterine Sarcoma at a Canadian Academic Centre.

OBJECTIVES: To determine the incidence of tissue morcellation during surgery for uterine sarcoma in a Canadian tertiary academic centre. METHODS: In this retrospective cohort study, the clinical charts of all women who underwent hysterectomy for uterine sarcoma at the Ottawa Hospital between April 1, 2007, and March 31, 2014, were reviewed for their clinical characteristics and details of surgical treatment. RESULTS: Sixty-six cases of uterine sarcoma were identified. The mean (± SD) age of patients was 62.1 ± 10 years, and 81.8% were postmenopausal. Of the tumours, 43.9% were carcinosarcomas, 28.8% were leiomyosarcomas, 13.6% were endometrial stromal sarcomas, 6.1% were adenosarcomas, 1.5% were uterine rhabdomyosarcomas, and 6.1% were undifferentiated sarcomas. None of the surgical specimens were morcellated by laparoscopic power morcellation, and 61/66 (92.4%) of patients had their surgery performed by a gynaecologic oncologist. In the remaining five women whose surgery was performed by a general gynaecologist (4 with leiomyosarcomas and 1 with undifferentiated uterine sarcoma), two surgical specimens were morcellated manually using a scalpel during the removal of presumed fibroids at hysterectomy performed by midline laparotomy. The first of these was a case performed as an emergency because of acute pelvic symptoms secondary to leiomyosarcoma, and the second case had a solitary leiomyosarcoma among multiple benign leiomyomata. CONCLUSION: Uterine sarcomas are uncommon, and morcellation is rarely performed but may nevertheless be performed in the surgical management of presumed fibroids. Further studies and the establishment of a national registry are needed to better quantify the risk of morcellation, to characterize clinical risk factors, and to provide surgical alternatives for women undergoing uterine surgery.

Objectifs : Déterminer l'incidence du morcellement tissulaire dans le cadre des chirurgies visant des sarcomes utérins au sein d'un centre universitaire tertiaire canadien. Méthodes : Dans le cadre de cette étude de cohorte rétrospective, les dossiers cliniques de toutes les femmes qui ont subi une hystérectomie en raison d'un sarcome utérin à L'Hôpital d'Ottawa, entre le 1er avril 2007 et le 31 mars 2014, ont été analysés en vue d'en tirer les caractéristiques cliniques et d'établir les détails du traitement chirurgical mis en œuvre. Résultats : Soixante-six cas de sarcome utérin ont été identifiés. L'âge moyen (± σ) des patientes était de 62,1 ± 10 ans et 81,8 % d'entre elles étaient postménopausées. Les tumeurs se répartissaient comme suit : 43,9 % d'entre elles étaient de carcinosarcomes; 28,8 %, des léiomyosarcomes; 13,6 %, des sarcomes du chorion cytogène; 6,1 %, des adénosarcomes; 1,5 %, des rhabdomyosarcomes utérins; et 6,1 %, des sarcomes indifférenciés. Aucun des prélèvements chirurgicaux n'a été soumis à un morcellement motorisé laparoscopique et, chez 61/66 (92,4 %) des patientes, la chirurgie a été menée par un gynéco-oncologue. Chez les cinq autres femmes (léiomyosarcomes dans quatre de ces cas et sarcome utérin indifférencié dans l'autre), pour lesquelles la chirurgie a été menée par un gynécologue généraliste, deux prélèvements chirurgicaux ont été morcelés de façon manuelle au moyen d'un scalpel pendant le retrait de fibromes présumés au moment d'une hystérectomie menée par laparotomie médiane. Dans le premier de ces deux cas, l'intervention a été menée d'urgence en raison de la présence de symptômes pelviens aigus attribuables à un léiomyosarcome, tandis que dans l'autre, la patiente en question présentait un léiomyosarcome solitaire situé parmi de multiples léiomyomes bénins. Conclusion : Les sarcomes utérins sont peu courants; de plus, bien qu'un morcellement soit rarement mis en œuvre, une telle intervention peut néanmoins en venir à être menée dans le cadre de la prise en charge chirurgicale de fibromes présumés. La tenue d'autres études et l'établissement d'un registre national s'avèrent requis pour mieux quantifier le risque lié au morcellement, pour définir les facteurs de risque cliniques et pour fournir des solutions de rechange chirurgicales aux femmes qui doivent subir une chirurgie utérine.