Advertisement

Laparoscopic management of uncommon benign uterine tumors: a systematic review

  • Zaki SleimanEmail author
  • Sara Hussein
  • Amani Mohsen
  • Aline Khazzaka
  • Alessandro Tropea
  • Antonio Biondi
Review Article
  • 57 Downloads

Abstract

The objective of the study was to review the reported cases of uncommon benign uterine tumors managed by laparoscopy. Medline database was searched using predefined search terms linked to atypical leiomyomas, leiomyoma variants, laparoscopy and morcellation. Quality of articles was assessed using Joanna Briggs Institute (JBI) critical appraisal tool. Due to heterogeneity in reporting characteristics of the patients, radiological findings, macroscopic findings, histological characteristics and follow-up, we performed a narrative synthesis. We included 109 cases of leiomyoma variants managed by laparoscopy. This stands for an incidence of 2.5% out of all the included laparoscopic management of leiomyomas. These cases were approached as classic leiomyoma. Only after the final histological results that their uncommon aspect was diagnosed. Intra-operatively, the management was similar to that of leiomyoma, with either myomectomy or hysterectomy performed depending on each individual case. Follow-up of these cases was variable: one case (0.9%) recurred as peritoneal sarcoma after 5 years of follow-up. It is important for the gynecologist, radiologist and pathologist to be aware about leiomyoma variants trying to diagnose them preoperatively. Strict follow-up of these cases is mandatory, because of the risk of recurrence and the very low but possible risk of future sarcomas.

Keywords

Uncommon benign uterine tumors Atypical leiomyomas Laparoscopy Diagnosis Surgical outcomes 

Notes

Funding

The work was not supported by any fund/grant.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent is not required for this type of study.

References

  1. 1.
    K Younas E Hadoura F Majoko A Bunkheila 2016 A review of evidence-based management of uterine fibroids Obstet Gynaecol 18 33 42  https://doi.org/10.1111/tog.12223 Google Scholar
  2. 2.
    AS Laganà D Vergara A Favilli 2017 Epigenetic and genetic landscape of uterine leiomyomas: a current view over a common gynecological disease Arch Gynecol Obstet 296 855 867  https://doi.org/10.1007/s00404-017-4515-5 CrossRefGoogle Scholar
  3. 3.
    AE Commandeur AK Styer JM Teixeira 2015 Epidemiological and genetic clues for molecular mechanisms involved in uterine leiomyoma development and growth Hum Reprod Update 21 593 615  https://doi.org/10.1093/humupd/dmv030 CrossRefGoogle Scholar
  4. 4.
    SG Vitale F Sapia AMC Rapisarda 2017 Hysteroscopic morcellation of submucous myomas: a systematic review Biomed Res Int 2017 6848250  https://doi.org/10.1155/2017/6848250 CrossRefGoogle Scholar
  5. 5.
    K Haber E Hawkins M Levie S Chudnoff 2015 Hysteroscopic morcellation: review of the manufacturer and user facility device experience (MAUDE) database J Minim Invasive Gynecol 22 110 114  https://doi.org/10.1016/j.jmig.2014.08.008 CrossRefGoogle Scholar
  6. 6.
    SE Ferguson C Tornos A Hummer 2007 Prognostic features of surgical stage I uterine carcinosarcoma Am J Surg Pathol 31 1653 1661  https://doi.org/10.1097/PAS.0b013e3181161ba3 CrossRefGoogle Scholar
  7. 7.
    SG Vitale AS Laganà S Capriglione 2017 Target therapies for uterine carcinosarcomas: current evidence and future perspectives Int J Mol Sci  https://doi.org/10.3390/ijms18051100 Google Scholar
  8. 8.
    SJ Robboy 2009 Robboy’s pathology of the female reproductive tract Churchill Livingstone/Elsevier EdinburghGoogle Scholar
  9. 9.
    J Abraham P Saldanha 2013 Morphological variants and secondary changes in uterine leiomyomas—is it important to recognize them? Int J Biomed Res 4 639  https://doi.org/10.7439/ijbr.v4i12.428 CrossRefGoogle Scholar
  10. 10.
    Kurman RJ, International Agency for Research on Cancer, World Health Organization 2014 WHO classification of tumours of female reproductive organs International Agency for Research on Cancer LyonGoogle Scholar
  11. 11.
    LM Roth RJ Reed 2000 Cotyledonoid leiomyoma of the uterus: report of a case Int J Gynecol Pathol 19 272 275CrossRefGoogle Scholar
  12. 12.
    S Ehdaivand RA Simon CJ Sung 2014 Incidental gynecologic neoplasms in morcellated uterine specimens: a case series with follow-up Hum Pathol 45 2311 2317  https://doi.org/10.1016/j.humpath.2014.07.018 CrossRefGoogle Scholar
  13. 13.
    JSY Ng A Han SH Chew J Low 2010 A clinicopathologic study of uterine smooth muscle tumours of uncertain malignant potential (STUMP) Ann Acad Med Singap 39 625 628Google Scholar
  14. 14.
    KK Deodhar P Goyal B Rekhi 2011 Uterine smooth muscle tumors of uncertain malignant potential and atypical leiomyoma: a morphological study of these grey zones with clinical correlation Indian J Pathol Microbiol 54 706 711  https://doi.org/10.4103/0377-4929.91500 CrossRefGoogle Scholar
  15. 15.
    Dall’Asta A, Gizzo S, Musarò A, 2014 Uterine smooth muscle tumors of uncertain malignant potential (STUMP): pathology, follow-up and recurrence Int J Clin Exp Pathol 7 8136 8142Google Scholar
  16. 16.
    HI Ha MC Choi JH Heo 2018 A clinicopathologic review and obstetric outcome of uterine smooth muscle tumor of uncertain malignant potential (STUMP) in a single institution Eur J Obstet Gynecol Reprod Biol 228 1 5  https://doi.org/10.1016/j.ejogrb.2018.06.003 CrossRefGoogle Scholar
  17. 17.
    BH Bacanakgil M Deveci E Karabuk Z Soyman 2017 uterine smooth muscle tumor of uncertain malignant potential: clinicopathologic-sonographic characteristics, follow-up and recurrence World J Oncol 8 76 80  https://doi.org/10.14740/wjon1031w CrossRefGoogle Scholar
  18. 18.
    EK Arleo PE Schwartz P Hui S McCarthy 2015 Review of leiomyoma variants Am J Roentgenol 205 912 921  https://doi.org/10.2214/AJR.14.13946 CrossRefGoogle Scholar
  19. 19.
    LB Schwartz M Zawin ML Carcangiu 1998 Does pelvic magnetic resonance imaging differentiate among the histologic subtypes of uterine leiomyomata? Fertil Steril 70 580 587CrossRefGoogle Scholar
  20. 20.
    M-J Kim Y-K Park J-H Cho 2002 Cotyledonoid dissecting leiomyoma of the uterus: a case report and review of the literature J Korean Med Sci 17 840 844  https://doi.org/10.3346/jkms.2002.17.6.840 CrossRefGoogle Scholar
  21. 21.
    D Moher L Shamseer M Clarke 2015 Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement Syst Rev 4 1  https://doi.org/10.1186/2046-4053-4-1 CrossRefGoogle Scholar
  22. 22.
    KC Wheeler DJ Warr SI Warsetsky LI Barmat 2016 Novel fumarate hydratase mutation in a family with atypical uterine leiomyomas and hereditary leiomyomatosis and renal cell cancer Fertil Steril 105 144 148  https://doi.org/10.1016/j.fertnstert.2015.09.034 CrossRefGoogle Scholar
  23. 23.
    TM Picerno MN Wasson AR Gonzalez Rios 2016 Morcellation and the incidence of occult uterine malignancy: a dual-institution review Int J Gynecol Cancer 26 149 155  https://doi.org/10.1097/IGC.0000000000000558 CrossRefGoogle Scholar
  24. 24.
    S Matsuoka I Kikuchi M Kitade 2010 Strategy for laparoscopic cervical myomectomy J Minim Invasive Gynecol 17 301 305  https://doi.org/10.1016/j.jmig.2009.12.020 CrossRefGoogle Scholar
  25. 25.
    MA Seidman T Oduyebo MG Muto 2012 Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms PLoS ONE 7 e50058  https://doi.org/10.1371/journal.pone.0050058 CrossRefGoogle Scholar
  26. 26.
    G Pados D Tsolakidis V Theodoulidis 2017 Prevalence of occult leiomyosarcomas and atypical leiomyomas after laparoscopic morcellation of leiomyomas in reproductive-age women Hum Reprod 32 2036 2041  https://doi.org/10.1093/humrep/dex258 CrossRefGoogle Scholar
  27. 27.
    F Raga M Sanz-Cortés EM Casañ 2009 Cotyledonoid dissecting leiomyoma of the uterus Fertil Steril 91 1269 1270  https://doi.org/10.1016/j.fertnstert.2008.08.131 CrossRefGoogle Scholar
  28. 28.
    H Tanaka K Toriyabe T Senda 2013 Cotyledonoid dissecting leiomyoma treated by laparoscopic surgery: a case report Asian J Endosc Surg 6 122 125  https://doi.org/10.1111/ases.12009 CrossRefGoogle Scholar
  29. 29.
    SG Vitale AS Laganà M Noventa 2018 Transvaginal bilateral sacrospinous fixation after second recurrence of vaginal vault prolapse: efficacy and impact on quality of life and sexuality Biomed Res Int 2018 5727165  https://doi.org/10.1155/2018/5727165 CrossRefGoogle Scholar
  30. 30.
    DD Rahn MM Mamik TVD Sanses 2011 Venous thromboembolism prophylaxis in gynecologic surgery: a systematic review Obstet Gynecol 118 1111 1125  https://doi.org/10.1097/AOG.0b013e318232a394 CrossRefGoogle Scholar
  31. 31.
    Sardo A Spiezio Di C Alviggi B Zizolfi 2013 Cervico-isthmic pregnancy successfully treated with bipolar resection following methotrexate administration: case report and literature review Reprod Biomed Online 26 99 103  https://doi.org/10.1016/j.rbmo.2012.10.005 CrossRefGoogle Scholar
  32. 32.
    U Broeck Van den C Meuleman C Tomassetti 2013 Effect of laparoscopic surgery for moderate and severe endometriosis on depression, relationship satisfaction and sexual functioning: comparison of patients with and without bowel resection Hum Reprod 28 2389 2397  https://doi.org/10.1093/humrep/det260 CrossRefGoogle Scholar
  33. 33.
    J Cavaco-Gomes M Martinho J Gilabert-Aguilar J Gilabert-Estélles 2017 Laparoscopic management of ureteral endometriosis: a systematic review Eur J Obstet Gynecol Reprod Biol 210 94 101  https://doi.org/10.1016/j.ejogrb.2016.12.011 CrossRefGoogle Scholar
  34. 34.
    P Vercellini L Carmignani T Rubino 2009 Surgery for deep endometriosis: a pathogenesis-oriented approach Gynecol Obstet Invest 68 88 103  https://doi.org/10.1159/000219946 CrossRefGoogle Scholar
  35. 35.
    AS Laganà SG Vitale MA Trovato 2016 Full-thickness excision versus shaving by laparoscopy for intestinal deep infiltrating endometriosis: rationale and potential treatment options Biomed Res Int 2016 3617179  https://doi.org/10.1155/2016/3617179 CrossRefGoogle Scholar
  36. 36.
    SG Vitale S Caruso AMC Rapisarda 2016 Biocompatible porcine dermis graft to treat severe cystocele: impact on quality of life and sexuality Arch Gynecol Obstet 293 125 131  https://doi.org/10.1007/s00404-015-3820-0 CrossRefGoogle Scholar
  37. 37.
    G Ferron A Gesson-Paute JM Classe D Querleu 2005 Feasibility of laparoscopic peritonectomy followed by intra-peritoneal chemohyperthermia: an experimental study Gynecol Oncol 99 358 361  https://doi.org/10.1016/j.ygyno.2005.06.043 CrossRefGoogle Scholar
  38. 38.
    R Angioli F Plotti S Capriglione 2016 Preoperative local staging of endometrial cancer: the challenge of imaging techniques and serum biomarkers Arch Gynecol Obstet 294 1291 1298  https://doi.org/10.1007/s00404-016-4181-z CrossRefGoogle Scholar
  39. 39.
    A Bellia SG Vitale AS Laganà 2016 Feasibility and surgical outcomes of conventional and robot-assisted laparoscopy for early-stage ovarian cancer: a retrospective, multicenter analysis Arch Gynecol Obstet 294 615 622  https://doi.org/10.1007/s00404-016-4087-9 CrossRefGoogle Scholar
  40. 40.
    Morrison J, Haldar K, Kehoe S, Lawrie TA (2012) Chemotherapy versus surgery for initial treatment in advanced ovarian epithelial cancer. Cochrane database Syst Rev CD005343 . doi: 10.1002/14651858.CD005343.pub3Google Scholar
  41. 41.
    SG Vitale S Capriglione G Zito 2019 Management of endometrial, ovarian and cervical cancer in the elderly: current approach to a challenging condition Arch Gynecol Obstet 299 299 315  https://doi.org/10.1007/s00404-018-5006-z CrossRefGoogle Scholar
  42. 42.
    V Weinberger L Minář M Felsinger 2018 Brenner tumor of the ovary—ultrasound features and clinical management of a rare ovarian tumor mimicking ovarian cancer Ginekol Pol 89 357 363  https://doi.org/10.5603/GP.a2018.0061 CrossRefGoogle Scholar
  43. 43.
    S Uccella A Cromi G Bogani 2013 Transvaginal specimen extraction at laparoscopy without concomitant hysterectomy: our experience and systematic review of the literature J Minim Invasive Gynecol 20 583 590  https://doi.org/10.1016/j.jmig.2013.02.022 CrossRefGoogle Scholar
  44. 44.
    L Peri M Musquera A Vilaseca 2015 Perioperative outcome and female sexual function after laparoscopic transvaginal NOTES-assisted nephrectomy World J Urol 33 2009 2014  https://doi.org/10.1007/s00345-015-1573-9 CrossRefGoogle Scholar
  45. 45.
    JH Kim YJ Choi DC Kim SJ Lee 2010 Leiomyosarcoma arising in a patient with prior mitotically active leiomyoma J Obstet Gynaecol Res 36 187 190  https://doi.org/10.1111/j.1447-0756.2009.01117.x CrossRefGoogle Scholar
  46. 46.
    FA Taran AL Weaver BS Gostout EA Stewart 2010 Understanding cellular leiomyomas: a case-control study Am J Obstet Gynecol 203 109.e1 6  https://doi.org/10.1016/j.ajog.2010.03.018 CrossRefGoogle Scholar
  47. 47.
    LC Hickman A Kotlyar S Shue T Falcone 2016 Hemostatic techniques for myomectomy: an evidence-based approach J Minim Invasive Gynecol 23 497 504  https://doi.org/10.1016/j.jmig.2016.01.026 CrossRefGoogle Scholar
  48. 48.
    Z Cheng L Xu Y Zhu 2009 Laparoscopic uterine vessels occlusion for the treatment of interstitial pregnancy J Laparoendosc Adv Surg Tech A 19 509 512  https://doi.org/10.1089/lap.2008.0361 CrossRefGoogle Scholar
  49. 49.
    A Ciavattini N Clemente G Delli Carpini 2017 Laparoscopic uterine artery bipolar coagulation plus myomectomy vs traditional laparoscopic myomectomy for “large” uterine fibroids: comparison of clinical efficacy Arch Gynecol Obstet 296 1167 1173  https://doi.org/10.1007/s00404-017-4545-z CrossRefGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  • Zaki Sleiman
    • 1
    Email author
  • Sara Hussein
    • 2
  • Amani Mohsen
    • 2
  • Aline Khazzaka
    • 2
  • Alessandro Tropea
    • 3
  • Antonio Biondi
    • 4
  1. 1.Department of Obstetrics and GynecologyLebanese American UniversityBeirutLebanon
  2. 2.Laboratory of Science and ResearchSaint Joseph UniversityBeirutLebanon
  3. 3.Department for the Treatment and Study of Abdominal Diseases and Abdominal TransplantationIRCCS-ISMETT (Istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione), University of Pittsburgh Medical Center ItalyPalermoItaly
  4. 4.Department of General Surgery and Medical Surgical SpecialtiesUniversity of CataniaCataniaItaly

Personalised recommendations