Progression of pelvic implants to complex atypical endometrial hyperplasia after uterine morcellation.
BACKGROUND
Supracervical hysterectomy, a surgical technique that involves removal of the uterus while preserving the cervix, places women at an increased risk for future morbidity.


METHODS
The patient presented 7 years after laparoscopic supracervical hysterectomy for benign disease, with pelvic pain, urinary frequency, abdominal bloating, and tenderness. Surgical exploration revealed myometrial implants, along with a larger mass on the mesentery of the sigmoid composed of endometrium with complex atypical hyperplasia in a patient without a prior history of complex atypical hyperplasia. The patient was symptom-free 6 months postoperatively.


CONCLUSIONS
Histology found during reoperation after laparoscopic supracervical hysterectomy includes endometriosis, residual endometrium, and leiomyomas. In this case, a woman with no prior history of endometrial atypia later developed complex adenomatous endometrial hyperplasia in a peritoneal implant. This finding adds to the list of possible complications after laparoscopic-assisted supracervical hysterectomy and uterine morcellation.
From the Department of Obstetrics and Gynecology and Pathology, Mayo Clinic Arizona, Phoenix, Arizona.
Lisa M
LM
Kill
Vasilis
V
Kapetanakis
Ann E
AE
McCullough
Javier F
JF
Magrina
D004714:Endometrial Hyperplasia / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D004715:Endometriosis / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007889:Leiomyoma / Q000473:pathology; D008875:Middle Aged; D019736:Prostheses and Implants / Q000009:adverse effects*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology
Donnez O, Jadoul P, Squifflet J, Donnez J. Iatrogenic peritoneal adenomyoma after laparoscopic subtotal hysterectomy and uterine morcellation. Fertil Steril 2006;86:1511–2.
Supracervical hysterectomy. ACOG Committee Opinion No. 388. American College of Obstetricians and Gynecologists. Obstet Gynecol 2007;110:1215–7.
Okaro EO, Jones KD, Sutton C. Long term outcome following laparoscopic supracervical hysterectomy. Br J Obstet Gynecol 2001;108:1017–20.
Sepilian V, Della Badia C. Iatrogenic endometriosis caused by uterine morcellation during a supracervical hysterectomy. Obstet Gynecol 2003;102:1125–7.
Hilger WS, Magrina JF. Removal of pelvic leiomyomata and endometriosis five years after supracervical hysterectomy. Obstet Gynecol 2006;108:772–4.
Knudsen JC, Lundorff P. Complex hyperplastic endometrium in a peritoneal leiomyoma following CISH hysterectomy. Gynecol Surg 2006;3:213–4.
Donnez O, Squifflet J, Leconte I, Jadoul P, Donnez J. Posthysterectomy pelvic adenomyotic masses observed in 8 cases out of a series of 1405 laparoscopic subtotal hysterectomies. J Minim Invasive Gynecol 2007;14:156–60.
Jacobson GF, Shaber RE, Armstrong MA, Hung YY. Hysterectomy rates for benign indications. Obstet Gynecol 2006;107:1278–83.
Lyons TL. Laparoscopic supracervical hysterectomy. Baillieres Clin Obstet Gynaecol 1997;11:167–79.
Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of “untreated” hyperplasia in 170 patients. Cancer 1985;56:403–12.