Port-site metastasis after laparoscopic morcellation of uterine leiomyosarcoma

Purpose: To discuss the morcellator-related risks in treating uterine leiomyosarcoma (LMS) with presumed leiomyoma, and the preoperative diagnosis of uterine leiomyosarcoma. Materials and Methods: The authors retrospectively analyzed one case of port-site metastasis after laparoscopic morcellation (LPM) of uterine LMS in thier department and reviewed the literature. Results: The 43-year-old woman with a uterine leiomyoma diagnosed via ultrasound underwent laparoscopic myomectomy outside this hospital, with an intraoperative frozen section showing leiomyosarcoma. One week later at the present hospital, she underwent hysterectomy, bilateral oophorectomy, and pelvic and para-aortic lymph node dissection, and postoperative chemotherapy with two courses of IAP program, and the total amount of external beam radiotherapy. Abdominal puncture and pelvic tumor recurrence occurred three months later, and the patient underwent tumor cytoreductive surgery and postoperative chemotherapy with one course of GD program. Recurrence of abdominal cavity occurred again one month after chemotherapy. After the abandonment of treatment, she died from dyscrasia. gastrointestinal bleeding, and cardiopulmonary failure two months after the second recurrence. Conclusions: For a presumed uterine leiomyoma, morcellation is associated with prognosis including death. Patients considering morcellation should be adequately counseled about the prevalence of cancerous and precancerous conditions prior to undergoing LPM.