Kitty Pavlakis1,2, Irini Messini1, Petros Yiannou1, Theofani Gavresea1, Dimitris Chrysanthakis1, Georgios Hilaris3,4, Theodoros Panoskaltsis5. 1. Pathology Department, IASO Women's Hospital, Maroussi, Greece. 2. Pathology Department, National and Kapodistrian University of Athens, Athens, Greece. 3. IASO Women's Hospital Athens Greece and Stanford University Hospital, Stanford, California, USA. 4. Stanford University Hospital, Stanford, California, USA. 5. 2nd Department of Obstetrics and Gynecology, Medical School National and Kapodistrian University of Athens, Athens, Greece.
Abstract
AIM: The study was conducted to delineate the histological problems in diagnosing uterine mesenchymal tumors in morcellated material. METHODS: All cases of morcellated uteri performed between 2008 and 2014 were reviewed. The incidence of unexpected malignancy, defined as any neoplasm with a clear-cut diagnosis of leiomyosarcoma (LMS) or endometrial stromal sarcoma (ESS), was noted. Cases with absolute discrepancy between the diagnosis of the morcellated tumor and the subsequent diagnosis were also included in the study. RESULTS: Out of 631 cases, a final diagnosis of LMS or ESS was made regarding three and five tumors, respectively. Patient age ranged from 25 to 48 years. Two further cases initially diagnosed as ESS proved to be endometrial stromal nodules with smooth muscle differentiation. Two cases were diagnosed as smooth muscle tumors with uncertain malignant potential and the patients remain free of disease. One tumor was diagnosed as an endometrial stromal neoplasm and proved to be benign and finally a leiomyoma variant presented with presumed peritoneal disease. CONCLUSION: Both endometrial stromal and smooth muscle tumors with malignant behavior can be encountered at a young age. Because of the limitations in histological evaluation, morcellated tumors may be overdiagnosed or underdiagnosed by pathologists.
AIM: The study was conducted to delineate the histological problems in diagnosing uterine mesenchymal tumors in morcellated material. METHODS: All cases of morcellated uteri performed between 2008 and 2014 were reviewed. The incidence of unexpected malignancy, defined as any neoplasm with a clear-cut diagnosis of leiomyosarcoma (LMS) or endometrial stromal sarcoma (ESS), was noted. Cases with absolute discrepancy between the diagnosis of the morcellated tumor and the subsequent diagnosis were also included in the study. RESULTS: Out of 631 cases, a final diagnosis of LMS or ESS was made regarding three and five tumors, respectively. Patient age ranged from 25 to 48 years. Two further cases initially diagnosed as ESS proved to be endometrial stromal nodules with smooth muscle differentiation. Two cases were diagnosed as smooth muscle tumors with uncertain malignant potential and the patients remain free of disease. One tumor was diagnosed as an endometrial stromal neoplasm and proved to be benign and finally a leiomyoma variant presented with presumed peritoneal disease. CONCLUSION: Both endometrial stromal and smooth muscle tumors with malignant behavior can be encountered at a young age. Because of the limitations in histological evaluation, morcellated tumors may be overdiagnosed or underdiagnosed by pathologists.