Unexpected Uterine Leiomyosarcoma During Laparoscopic Hysterectomy Treated 6 Months With Ulipristal Acetate and Contained Power Morcellation

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• 作者：Olav Istre ; MD ; PhD ; ^{oistre@gmail.com}
• 关键词：Contained morcellation ; Leiomyoma sarcoma ; Myoma ; Ulipristal acetate
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：24
• 期：2
• 页码：198
• 全文大小：299 K
• 卷排序：24

文摘

A 45-year-old woman with a symptomatic uterine myoma suffering from heavy menstrual bleeding, incontinence, and pain pressure received ulipristal acetate (UPA [Esmya; Gideon Richter, Budapest, Hungary]) for 6 months.SettingA Minimal Invasive Gynecology surgery Unit in Chopenhagen Denmark.InterventionHer symptoms were reduced; however, after 3 months on UPA, she was then admitted because of increased pain. A high level of C-reactive protein was found, and necrosis of the myoma was assumed to be the reason. In December 2015, she opted for a laparoscopic hysterectomy because of the increasing symptoms and lack of conviction that the medical therapy would be sufficient.Measurements and Main ResultsUltrasound showed a 106 × 73 mm myoma with no abnormal blood flow or lacuna of fluid inside the myoma; there was no suspicion of malignancies. The video and the report have been approved by the local institutional review board. The weight of the contained morcellated uterus was 575 g, and pathology showed a malignant leiomyoma sarcoma. A postoperative positron emission tomographic scan showed 4 metastatic processes in the lungs.ConclusionsThe Food and Drug Administration has approved the PneumoLiner (Advanced Surgical Concepts, Dublin, Ireland); however, they also stress the point that the device “has not been proven to reduce the risk of spreading cancer.” In this case, the UPA treatment actually led to a delay in the diagnosis, potentially with a larger or even metastatic tumor as a consequence.