title: The value of re-exploration in patients with inadvertently morcellated uterine sarcoma.
abstract: OBJECTIVE
  To describe the role of immediate re-exploration in patients with inadvertently morcellated uterine leiomyosarcoma (ULMS) and smooth muscle tumors of uncertain malignant potential (STUMP).
  
  
  METHODS
  All patients with ULMS/STUMP who were managed or referred to the participating institutions from January 2005 to January 2012 following minimally invasive gynecology surgery with morcellation were detected through the pathology database. The diagnosis was confirmed by gynecologic-pathologists following post-surgery pathology review.
  
  
  RESULTS
  Twenty-one patients with the diagnosis of ULMS (N = 15) and STUMP (N = 6) after morcellation were identified. The median age of occurrence was 46 years (range, 25-58 years). Median follow-up duration was 27 months (range, 1.8-93.1 months). None of the 21 patients had documented evidence of extra-uterine disease at the time of original surgery. Ultimately 12 patients were immediately re-explored to complete staging. The median time to the staging surgery was 33 days (range 15-118 days). Two (28.5%) out of seven patients with presumed stage I ULMS and one (25%) out of four patients with presumed stage I STUMP had significant findings of disseminated intraperitoneal disease detected at immediate surgical re-exploration. One of the 8 patients with confined early ULMS and STUMP at the second surgery had intraperitoneal recurrence, while the remaining 7 patients have had no recurrence and remain disease free.
  
  
  CONCLUSIONS
  Surgical re-exploration is likely to show findings of disseminated peritoneal sarcomatosis in a significant number of patients diagnosed with ULMS after a morcellation procedure. Findings from re-exploration can contribute to the knowledge of natural history of morcellated ULMS/STUMP and allow for accurate prognostication.
authors.affiliation: Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, United States; Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard School of Medicine, Boston, MA, United States.
authors.forename: Titilope
authors.initials: T
authors.lastname: Oduyebo
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard School of Medicine, Boston, MA, United States.
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Rauh-Hain
authors.affiliation: Division of Women's & Perinatal Pathology, Department of Pathology & Laboratory Medicine, Brigham & Women's Hospital, United States; Harvard School of Medicine, Boston, MA, United States.
authors.forename: Emily E
authors.initials: EE
authors.lastname: Meserve
authors.affiliation: Division of Women's & Perinatal Pathology, Department of Pathology & Laboratory Medicine, Brigham & Women's Hospital, United States; Harvard School of Medicine, Boston, MA, United States.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Seidman
authors.affiliation: Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, United States; Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard School of Medicine, Boston, MA, United States.
authors.forename: Emily
authors.initials: E
authors.lastname: Hinchcliff
authors.affiliation: Harvard School of Medicine, Boston, MA, United States; Dana Farber Cancer Institute, Boston, MA, United States.
authors.forename: Suzanne
authors.initials: S
authors.lastname: George
authors.affiliation: Division of Women's & Perinatal Pathology, Department of Pathology & Laboratory Medicine, Brigham & Women's Hospital, United States; Harvard School of Medicine, Boston, MA, United States.
authors.forename: Bradley
authors.initials: B
authors.lastname: Quade
authors.affiliation: Division of Women's & Perinatal Pathology, Department of Pathology & Laboratory Medicine, Brigham & Women's Hospital, United States; Harvard School of Medicine, Boston, MA, United States.
authors.forename: Marisa R
authors.initials: MR
authors.lastname: Nucci
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard School of Medicine, Boston, MA, United States.
authors.forename: Marcela G
authors.initials: MG
authors.lastname: Del Carmen
authors.affiliation: Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, United States; Harvard School of Medicine, Boston, MA, United States. Electronic address: mmuto@partners.org.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Muto
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery; D007890:Leiomyosarcoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery*; D009366:Neoplasm Seeding; D010534:Peritoneal Neoplasms / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Fibroids; Leiomyoma; Leiomyosarcoma; Morcellation; Smooth muscle tumor of uncertain potential; Uterine