Diagnosis of malignant mesenchymal uterine tumors by hysteroscopic excisional biopsy.
OBJECTIVE
To emphasize the need for histologic evaluation of intrauterine lesions. Six cases of unexpected mesenchymal uterine tumors were diagnosed following pathologic review of specimens obtained during hysteroscopy to evaluate intrauterine lesions.


METHODS
Retrospective chart review (Canadian Task Force classification II-3).


METHODS
Large tertiary care medical center.


METHODS
Four postmenopausal and two perimenopausal women with uterine mesenchymal tumors.


METHODS
Hysteroscopy and staging laparotomy.


RESULTS
Mean age of the patients was 57.5 +/- 19.5 years (mean +/- 2SD). Four women (67%) were postmenopausal. Three patients had abnormal uterine bleeding, one had a cervical mass, and the other two were asymptomatic and referred for evaluation of thick endometrium detected by routine ultrasound, which had been preformed as part of their annual check-up. In all cases, the initial hysteroscopic diagnosis was endometrial polyp or submucous myoma. Following the pathologic review, all six women underwent complete staging laparotomy. In two women, there was no residual disease in the surgical specimen. None of the patients had extrauterine spread of the disease. At mean follow-up of 21.5 +/- 9.7 months (mean +/- 2SD), all women were asymptomatic.


CONCLUSIONS
Intrauterine lesions erroneously considered to be benign endometrial polyps or myomas can turn out to be malignant mesenchymal uterine tumors. Hysteroscopic evaluation and biopsy might offer early diagnosis and treatment to these patients.
Shveiky
David
D
Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Revel
Ariel
A
Rojansky
Nathan
N
Benshushan
Abraham
A
Shushan
Asher
A
D018195:Adenosarcoma / Q000473:pathology / Q000601:surgery; D001706:Biopsy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015907:Hysteroscopy; D007890:Leiomyosarcoma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery; D014599:Uterus / Q000473:pathology