Ed lesions did not show any definite infiltration or invasion of adjacent tissue. Consequently, presence or absence of significant cytologic atypia, mitoses, and necrosis were the basis for determining whether the buy GSK2334470 disseminated tissue represented a benign, atypical, or malignant lesion. In a small number of cases, immunohistochemical staining for smooth muscle actin and/or desmin was used to confirm further that the lesions represented smooth muscle rather than a reactive fibroblastic proliferation. Proliferation indices (MiB-1/Ki-67 staining) were also evaluated in some of these lesions. Material from a case of iatrogenic disseminated peritoneal leiomyomatosis (DPL) following uterine morcellation showed a proliferation index of 1 [6]. A similar proliferation index was identified in one case of disseminated STUMP (case 11967625 #9). In contrast, another case of STUMP showed a proliferation index of 40 (case #11). Residual LMS in case #12 showed a proliferative index of 5 . Disseminated sarcoma showed proliferative indices of 10 (case #2) and 80 (case #18).Follow-up clinical data showed that the only mortality in this case series occurred in patients with diagnoses of leiomyosarcoma; all other patients remain alive at last follow-up. Of the seven LMS cases for which follow-up was available, four showed evidence of peritoneal dissemination (57.1 , 95 confidence internal 25.0?84.2 ). Of these, three patients have died (75 , 95 1313429 confidence internal 30.1?8.7 ), with an average post-diagnosis survival of 24.3 months (95 confidence interval 8.4?0.3 months). The remaining patient with documented dissemination was alive at 39 months, and the cases without dissemination were alive with an average follow-up interval of 29.7 months, including one case (#12) with residual LMS identified at the site of prior hysterectomy on re-exploration but without any evidence of disseminated disease.DiscussionPower morcellation, while an effective technique to facilitate minimally invasive surgery of even large uterine masses, carries a risk of dispersing the tumor into the peritoneal cavity. This is particularly concerning considering the inevitable albeit uncommon occurrence of a potentially malignant tumor that is preoperatively misclassified and morcellated on the assumption that it is benign [7?]. The findings presented here add to the existing literature of case reports of both non-neoplastic and neoplastic tissues being disseminated throughout the peritoneum as a result of power morcellation, including tissue of both endometrial (endometrium, endometriosis, endometrial adenocarcinoma, stromal sarcoma) and myometrial (myometrium and the spectrum of smooth muscle neoplasms) origin [6,10?1]. Of note, one of the 1078 cases of uterine morcellations performed at BWH with a post-operative diagnosis of leiomyoma has previously been described as being associated with subsequent development of disseminated peritoneal leiomyomatosis (DPL) [6]. GSK429286A chemical information Despite these multiple case reports, no prospective study of these complications has been performed to date.Unexpected Diagnoses at the Time of MorcellationThe data in this study show that unexpected diagnoses of variant leiomyoma, atypia, or malignancy will occur in approxMorcellation and Peritoneal Disseminationimately 1 of cases with a preoperative diagnosis of benign uterine leiomyoma. The in-house incidence of unexpected leiomyosarcoma was 0.09 (95 confidence interval 0.00?0.52 ). This rate is similar to that reported by Le.Ed lesions did not show any definite infiltration or invasion of adjacent tissue. Consequently, presence or absence of significant cytologic atypia, mitoses, and necrosis were the basis for determining whether the disseminated tissue represented a benign, atypical, or malignant lesion. In a small number of cases, immunohistochemical staining for smooth muscle actin and/or desmin was used to confirm further that the lesions represented smooth muscle rather than a reactive fibroblastic proliferation. Proliferation indices (MiB-1/Ki-67 staining) were also evaluated in some of these lesions. Material from a case of iatrogenic disseminated peritoneal leiomyomatosis (DPL) following uterine morcellation showed a proliferation index of 1 [6]. A similar proliferation index was identified in one case of disseminated STUMP (case 11967625 #9). In contrast, another case of STUMP showed a proliferation index of 40 (case #11). Residual LMS in case #12 showed a proliferative index of 5 . Disseminated sarcoma showed proliferative indices of 10 (case #2) and 80 (case #18).Follow-up clinical data showed that the only mortality in this case series occurred in patients with diagnoses of leiomyosarcoma; all other patients remain alive at last follow-up. Of the seven LMS cases for which follow-up was available, four showed evidence of peritoneal dissemination (57.1 , 95 confidence internal 25.0?84.2 ). Of these, three patients have died (75 , 95 1313429 confidence internal 30.1?8.7 ), with an average post-diagnosis survival of 24.3 months (95 confidence interval 8.4?0.3 months). The remaining patient with documented dissemination was alive at 39 months, and the cases without dissemination were alive with an average follow-up interval of 29.7 months, including one case (#12) with residual LMS identified at the site of prior hysterectomy on re-exploration but without any evidence of disseminated disease.DiscussionPower morcellation, while an effective technique to facilitate minimally invasive surgery of even large uterine masses, carries a risk of dispersing the tumor into the peritoneal cavity. This is particularly concerning considering the inevitable albeit uncommon occurrence of a potentially malignant tumor that is preoperatively misclassified and morcellated on the assumption that it is benign [7?]. The findings presented here add to the existing literature of case reports of both non-neoplastic and neoplastic tissues being disseminated throughout the peritoneum as a result of power morcellation, including tissue of both endometrial (endometrium, endometriosis, endometrial adenocarcinoma, stromal sarcoma) and myometrial (myometrium and the spectrum of smooth muscle neoplasms) origin [6,10?1]. Of note, one of the 1078 cases of uterine morcellations performed at BWH with a post-operative diagnosis of leiomyoma has previously been described as being associated with subsequent development of disseminated peritoneal leiomyomatosis (DPL) [6]. Despite these multiple case reports, no prospective study of these complications has been performed to date.Unexpected Diagnoses at the Time of MorcellationThe data in this study show that unexpected diagnoses of variant leiomyoma, atypia, or malignancy will occur in approxMorcellation and Peritoneal Disseminationimately 1 of cases with a preoperative diagnosis of benign uterine leiomyoma. The in-house incidence of unexpected leiomyosarcoma was 0.09 (95 confidence interval 0.00?0.52 ). This rate is similar to that reported by Le.
