Mioma en remanente cervical tras histerectomía supracervical laparoscópica, presentación de un caso y revisión de la literatura / Myoma in cervical remnant after laparoscopic supracervical hysterectomy, case report and literature review

INTRODUCCIÓN: Los leiomiomas uterinos son el tumor pélvico más frecuente en la mujer, derivan de las células musculares lisas del miometrio y pueden localizarse en cualquiera de las porciones uterinas. Se clasifican según su relación con las diferentes capas del útero mediante la clasificación de la FIGO. Pueden ser asintomáticos o producir síntomas como sangrado, problemas reproductivos o dolor por compresión de estructuras vecinas. El tratamiento puede ser médico o quirúrgico, teniendo dentro de este último grupo, la posibilidad de realizar una miomectomía o una histerectomía total o subtotal. La histerectomía subtotal permite mantener el cérvix uterino, de tal forma que la técnica quirúrgica es más sencilla, sin embargo, requiere de la morcelación de la pieza para su extracción; mientras que la histerectomía total elimina el riesgo de recidiva de la patología uterocervical, aunque precisa de una mayor curva de aprendizaje. CASO CLÍNICO: Presentamos el caso de una paciente de 52 años a la que se le realizó una histerectomía supracervical laparoscópica por miomas. Posteriormente, se objetivó la aparición de un nuevo mioma en el remanente cervical, que requirió de una traquelectomía vía vaginal. CONCLUSIÓN: La histerectomía subtotal laparoscópica en úteros con múltiples miomas puede tener como efecto adverso la recidiva miomatosa en el cérvix o la aparición de miomas parasitarios secundarios a la morcelación uterina no estanca. Además, implica continuar con el cribado para la prevención del cáncer de cérvix uterino.

BACKGROUND: Uterine leiomyomas are the most frequent pelvic tumor in women. They derive from smooth muscle cells of the myometrium and can be in any of the uterine parts. They are classified according to their relationship with the different layers of the uterus by the FIGO classification. Uterine leiomyomas can be asymptomatic or produce symptoms such as compression pain, reproductive problems and metrorrhagia. The treatment can be medical or surgical. Within this last group there is the possibility of performing a myomectomy or a total or subtotal hysterectomy. The subtotal hysterectomy allows the uterine cervix to be maintained and therefore the surgical technique is simpler. However, it requires the morcellation of the piece for its removal. Alternatively, total hysterectomy eliminates the risk of recurrence of uterocervical pathology, but this procedure presents a steeper learning curve. CLINICAL CASE: We present the case of a patient of 52 years who underwent a laparoscopic supracervical hysterectomy for myomas. Subsequently, the appearance of a new myoma in the cervical remnant was observed, which required a vaginal trachelectomy. CONCLUSION: Laparoscopic subtotal hysterectomy in myomatous uterus can have as an adverse effect myomatous recurrence in the cervix or the appearance of parasitic myomas secondary to non-contained uterine morcellation. In addition, it involves continuing screening for the prevention of cervical cancer.

Morcelamento elétrico de tecido uterino: qual o risco potencial de disseminação de neoplasias malignas? / Electrical uterine tissue morbidity: what is the potential risk of malignant neoplasm spread?

O Food and Drug Administration (FDA) fez um alerta de segurança em relação ao risco potencial de disseminação de neoplasias malignas pelo uso do morcelador elétrico durante procedimentos minimamente invasivos. Esse artigo visa avaliar as evidências científicas sobre morcelamento uterino em relação ao risco de disseminação de câncer, sendo abordados a incidência de sarcoma uterino entre as mulheres previamente diagnosticadas com doença uterina benigna aparente, a possibilidade de avaliação pré-operatória desse risco, o posicionamento das principais sociedades médicas em relação à utilização do morcelador elétrico e as repercussões na prática clínica após as recomendações do FDA.(AU)

The US Food and Drug Administration (FDA) released a safety communication advising the potential risk of inadvertent spread of cancer cellsafter the use of electrical morcellator in minimally invasive procedures. This article aims to evaluate the scientific evidence regarding the risk of spread of cancer after uterine morcellation, the incidence of uterine sarcoma among women diagnosed with benign uterine disease, the possibility of preoperative assessment of this risk, the main medical societies positions statements regarding theuse of electric morcellation and the FDA recommendation`s impact on clinical practice. A review of the literature and a research of the main medical societies positions statements regarding the use of electric morcellation in minimally invasive surgeries were done.(AU)

Incidence of Occult Uterine Pathology in Women Undergoing Hysterectomy With Pelvic Organ Prolapse Repair.

OBJECTIVES: The objectives of this study are to determine the incidence of and associated risk factors for occult uterine pathology in patients undergoing hysterectomy with pelvic organ prolapse (POP) repair. METHODS: Medical records were reviewed from all cases of hysterectomy with POP surgery at a tertiary medical center from January 2007 through July 2014. Exclusion criteria included known endometrial hyperplasia or malignancy. A power calculation determined that 1000 subjects would demonstrate a lower rate of leiomyosarcoma in a urogynecology population compared to the rate of 1:352 reported by the Food and Drug Administration. RESULTS: There were 1196 cases identified with a mean age of 62.3 ± 11.3 years and body mass index of 27.8 ± 5.7. Most patients were white (95.5%) and postmenopausal (81.6%). Malignancy was present in 3 (0.3%) specimens. Seven (0.6%) specimens had endometrial hyperplasia. This overall abnormal pathology incidence of 0.8%, with 95% confidence interval of 0% to 1.4% is significantly lower than published rates of 2.6% (P < 0.001). There were no specimens with sarcoma (rate of 0%; 95% confidence interval, 0%-0.2%). There were no associations between demographic or clinical variables with the presence of hyperplasia and/or malignancy. CONCLUSIONS: The incidence of uterine hyperplasia/malignancy and sarcoma in women undergoing hysterectomy with POP were both significantly lower than previously published values in other populations. The use of power morcellation in urogynecologic populations should be revisited as the incidence of occult pathology is lower than the general population, and a condition-specific risk profile should be considered in the informed consent process.