Miscellaneous uterine malignant neoplasms detected during hysteroscopic surgery.
OBJECTIVE
To estimate the incidence of incidental miscellaneous uterine malignant neoplasms other than endometrioid adenocarcinoma detected during routine resectoscopic surgery in women with abnormal uterine bleeding (AUB) and to examine the effect of hysteroscopic surgery on long-term clinical outcome.


METHODS
Prospective cohort study (Canadian Task Force classification II-3).


METHODS
University-affiliated teaching hospital.


METHODS
Women with AUB.


METHODS
From January 1, 1990, through December 31, 2008, one of the authors (G.A.V.) and several fellows performed primary hysteroscopic surgery at St. Joseph's Health Care in 3892 women with AUB. Of the 7 with malignant disease, one underwent hysteroscopic partial (n = 1) or complete (n = 6) rollerball electrocoagulation or endomyometrial resection. After diagnosis of uterine cancer, the women were counseled about the disease and management in accord with established clinical practice guidelines. Follow-up with office visits and telephone interviews ranged from 2 to 8 years (median, 6 years).


RESULTS
Of the 3892 women, 4 had undiagnosed and 3 had suspected miscellaneous uterine malignant neoplasms including 1 endometrial stromal sarcoma, 2 carcinosarcomas, 2 atypical polypoid adenomyomas of the endometrium, 1 minimal deviation adenocarcinoma of the cervix, and 1 smooth-muscle tumor of uncertain malignant potential. At 2 to 8 years of follow-up, 1 patient died accidentally after 1 year, 1 died of carcinomatosis of either coexisting breast cancer or a carcinosarcoma (postmortem examination was declined) after 1 year, and 5 were alive and well.


CONCLUSIONS
Resectoscopic surgery in women with miscellaneous uterine malignant lesions not adversely affect 5-year survival and long-term prognosis.
Department of Obstetrics and Gynecology, University of Western Ontario, London, Ontario, Canada. george.vilos@sjhc.london.on.ca
George A
GA
Vilos
Fawaz
F
Edris
Basim
B
Abu-Rafea
Jackie
J
Hollett-Caines
Helen C
HC
Ettler
Awatif
A
Al-Mubarak
D000328:Adult; D000369:Aged, 80 and over; D004564:Electrocoagulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015907:Hysteroscopy; D015994:Incidence; D033162:Incidental Findings; D008796:Metrorrhagia / Q000601:surgery*; D008875:Middle Aged; D018193:Neoplasms, Complex and Mixed / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D009864:Ontario / Q000453:epidemiology; D018235:Smooth Muscle Tumor / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D016019:Survival Analysis; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery