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Risk of Occult Uterine Sarcoma in Women Undergoing Hysterectomy for Benign Indications [12]

INTRODUCTION: The use of intracorporeal morcellation at the time of gynecologic surgery is under scrutiny as a result of concerns over the dissemination of occult uterine malignancies. We sought to determine the frequency of unsuspected sarcoma identified postoperatively in women undergoing surgery for benign gynecologic conditions at our institution. METHODS: Patients undergoing hysterectomy for benign gynecologic indications from 2001 to 2012 at our institution were identified. Patients who did not have a preoperative suspicion for malignancy and were found to have uterine sarcoma on pathology postoperatively were considered to have an occult uterine sarcoma. Relevant clinical and pathologic data were collected. RESULTS: A total of 10,130 hysterectomies for benign gynecologic indications were performed between 2000 and 2014. Among these, nine patients were found to have uterine sarcoma with an overall rate of 9 occult sarcomas per 10,000 hysterectomies. These malignancies included five leiomyosarcomas, two endometrial stromal sarcomas, and two uterine adenosarcomas. Median age was 39 years (range 25–64 years). The most common surgical indications were abnormal bleeding (78%) and leiomyoma (56%). Cases included five total abdominal hysterectomies, three total vaginal hysterectomies, and one supracervical hysterectomy. One case required manual morcellation during abdominal hysterectomy. Power morcellation was not used in any of the cases. CONCLUSION: In summary, occult uterine sarcoma occurs in less than 0.1% of hysterectomies. The frequency is lower than the rate derived by the U.S. Food and Drug Administration in their pooled analysis. Institutional practices and regional referral patterns may affect local rates of occult sarcoma and should be considered during patient counseling and when developing clinical recommendations.