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Development of Uterine Smooth Muscle Tumour of Uncertain Malignant Potential (STUMP) After Laparoscopic Myomectomy of an Atypical Leiomyoma
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 operative complications, mean hospital stay, reoccurrence, need for adjuvant radiation/chemotherapy were documented and compared. Setting: Inner City Community Hospital. Patients: 37 patients with early cervical cancer underwent surgical treatments. 20 patients underwent robotic-assisted radical hysterectomy vs.17 patients underwent abdominal radical. Intervention: Robotic assisted radical hysterectomy compared to Abdominal radical Hysterectomy for the treatment of early cervical cancer. Measurements and Main Results: There was no statistical significance found in the demographics. Those treated with robotic laparoscopic surgery had an average hospital length of stay of 1.9 days in comparison to 10 days in the laparotomy group, with a p value of 0.06. The median blood loss for the laparoscopic group was 100cc when compared to 500cc in the laparotomy group, with a p value of \0.00001 The blood transfusion rate intraoperatively in the robotic group was 0 when compared to 3 in the laparotomy group, with a p value of 0.08. The nodal yield (median: 15 robotic, 14 laparotomy) with a p-value of 0.6368 and surgical margins (1 robotic, 1 laparotomy) with a p-value of 0.8753 were similar in both groups and no statistical significance was found. The overall recurrence rate is 3 in 37 with 1 out of 20 (5%) of laparoscopic cases and 2 out of 17 (12%) of open cases. Conclusion: Robotic surgery is well established as a safe and feasible treatment of early cervical cancer. In this study, survival outcome is equivalent to open surgery with the added advantage of shorter hospital stay, decreased blood loss and decreased post operative complications.
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788 Laparoscopic Technique for Central Early Stage Recurrent Cervical Cancer Kang K, Duan H, Wang Y. Minimally Invasive Gynaecology Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Dongcheng District, Beijing, China Study Objective: The aim of this study is to establish the feasibility and introduce the skills of the management of central early stage recurrent cervival cancer by laparoscopy. Design: Prospective interventional study. Setting: This investigation was conducted at Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Patients: Three patients were initially diagnosed with Stage Ib-IIa squamous carcinoma of the uterine cervix. And radical hysterectomy with pelvic lymphadenectomy were performed . Adjuvant chemotherapy was given.2-5 years later, the vagina end of recurrence of cervival cancer diagnosed and treated with laparoscopy. Intervention: The laparoscopic procedure was vaginalectomy including pelvic sidewall around vagina, a complete pathological response was confirmed afterwards. Key skills including:Bilateral ureters should be dissociated adequately,diluted adrenalin (1:200000) was injected into vaginal wall (point of the injection should be far away from the neoplasms),one tissue forceps with gauze push the end of vaginal stump,diluted methylene blue solution is used to full fill with bladder,dissection of vesicovaginal space, rectovaginal space and para vaginal tissues.Resect the residual vaginal and para vaginal tissues totally from the vulva, and suture the cut.
787 Development of Uterine Smooth Muscle Tumour of Uncertain Malignant Potential (STUMP) After Laparoscopic Myomectomy of an Atypical Leiomyoma Po LK, Liu GY. Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Study Objective: To describe a case of aggressive STUMP implants after laparoscopic power morcellation of an atypical leiomyoma. Design: Case report. Setting: Academic tertiary referral hospital. Patients: A healthy 48-year old woman. Intervention: Total abdominal hysterectomy, bilateral salpingoophorectomy, total omentectomy and removal of multiple large abdominal tumours. Measurements and Main Results: The patient initially underwent a laparoscopic myomectomy to remove a 15cm posterior cervical leiomyoma extending to the right broad ligament. Power morcellation was used to extract the tissue. The pathology showed a smooth muscle tumour with atypical features. The nature of the necrosis zones was uncertain and may have represented infarcts or tumour cell necrosis. The mitotic counts were 3/10 high power field (HPF). The patient remained asymptomatic for two years. She then presented with acute abdominal pain and bloating. Ultrasound revealed the presence of multiple large uterine masses felt to be uterine leiomyoma arising from the surface of the uterus with one extending to the liver and another extending up to the left upper quadrant. Given the relatively rapid development and growth, a leiomyosarcoma could not be excluded. She underwent a laparotomy for a total abdominal hysterectomy. Intraoperatively, multiple large solid and cystic masses were found to be arising from the omentum, right anterior abdominal wall, and right upper quadrant retroperitoneal to the liver. A large uterine mass involving the right adnexa was noted. Subsequent pathology was consistent with a STUMP tumour where the mitotic counts were 15/10 HPF, focal necrosis of undetermined nature and focal mild to moderate cytologic atypia. Conclusion: Patients who undergo uterine preserving surgical management of leiomyoma should have the pathology reviewed by a gynecologic pathologist. Close regular surveillance is indicated in patients shown to have any atypical features of the leiomyoma on pathology.
Measurements and Main Results: Mean time of the procedure was 137minutes (range 95-150 minutes) and blood lose was less than 200ml without any serious complication. Currently, Follow for up to 37 months (range 27-37 months), the patients were well and there are no signs of disease. Conclusion: Laparoscopic vaginalectomy is a safe and feasible way to deal with early stage recurrent cervical cancer.
789 Incidental Small Ovarian Surface Serous Carcinoma With Miliary Abdominal Seeding During Robotic-Assisted Total Hysterectomy Wang C-W, Chen C-H, Liu W-M. Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan Study Objective: To report a case in which incidental finding of extremely small ovarian surface tumor with abdominal miliary seeding during roboticassisted total hysterectomy. Design: Case report. Setting: University-affiliated teaching hospital. Patients: A 53 year-old women, Gravida 0 Para 0, who presented with dysmenorrhea and adenomyosis was admitted initially for robotic-assisted total hysterectomy. Intraoperatively, an incidental 0.5 cm right ovarian surface tumor noted with pelvic wall miliary tumors. Intraoperative frozen section revealed carcinoma both for ovarian tumor and pelvic
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788 Laparoscopic Technique for Central Early Stage Recurrent Cervical Cancer Kang K, Duan H, Wang Y. Minimally Invasive Gynaecology Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Dongcheng District, Beijing, China Study Objective: The aim of this study is to establish the feasibility and introduce the skills of the management of central early stage recurrent cervival cancer by laparoscopy. Design: Prospective interventional study. Setting: This investigation was conducted at Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Patients: Three patients were initially diagnosed with Stage Ib-IIa squamous carcinoma of the uterine cervix. And radical hysterectomy with pelvic lymphadenectomy were performed . Adjuvant chemotherapy was given.2-5 years later, the vagina end of recurrence of cervival cancer diagnosed and treated with laparoscopy. Intervention: The laparoscopic procedure was vaginalectomy including pelvic sidewall around vagina, a complete pathological response was confirmed afterwards. Key skills including:Bilateral ureters should be dissociated adequately,diluted adrenalin (1:200000) was injected into vaginal wall (point of the injection should be far away from the neoplasms),one tissue forceps with gauze push the end of vaginal stump,diluted methylene blue solution is used to full fill with bladder,dissection of vesicovaginal space, rectovaginal space and para vaginal tissues.Resect the residual vaginal and para vaginal tissues totally from the vulva, and suture the cut.
787 Development of Uterine Smooth Muscle Tumour of Uncertain Malignant Potential (STUMP) After Laparoscopic Myomectomy of an Atypical Leiomyoma Po LK, Liu GY. Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Study Objective: To describe a case of aggressive STUMP implants after laparoscopic power morcellation of an atypical leiomyoma. Design: Case report. Setting: Academic tertiary referral hospital. Patients: A healthy 48-year old woman. Intervention: Total abdominal hysterectomy, bilateral salpingoophorectomy, total omentectomy and removal of multiple large abdominal tumours. Measurements and Main Results: The patient initially underwent a laparoscopic myomectomy to remove a 15cm posterior cervical leiomyoma extending to the right broad ligament. Power morcellation was used to extract the tissue. The pathology showed a smooth muscle tumour with atypical features. The nature of the necrosis zones was uncertain and may have represented infarcts or tumour cell necrosis. The mitotic counts were 3/10 high power field (HPF). The patient remained asymptomatic for two years. She then presented with acute abdominal pain and bloating. Ultrasound revealed the presence of multiple large uterine masses felt to be uterine leiomyoma arising from the surface of the uterus with one extending to the liver and another extending up to the left upper quadrant. Given the relatively rapid development and growth, a leiomyosarcoma could not be excluded. She underwent a laparotomy for a total abdominal hysterectomy. Intraoperatively, multiple large solid and cystic masses were found to be arising from the omentum, right anterior abdominal wall, and right upper quadrant retroperitoneal to the liver. A large uterine mass involving the right adnexa was noted. Subsequent pathology was consistent with a STUMP tumour where the mitotic counts were 15/10 HPF, focal necrosis of undetermined nature and focal mild to moderate cytologic atypia. Conclusion: Patients who undergo uterine preserving surgical management of leiomyoma should have the pathology reviewed by a gynecologic pathologist. Close regular surveillance is indicated in patients shown to have any atypical features of the leiomyoma on pathology.
Measurements and Main Results: Mean time of the procedure was 137minutes (range 95-150 minutes) and blood lose was less than 200ml without any serious complication. Currently, Follow for up to 37 months (range 27-37 months), the patients were well and there are no signs of disease. Conclusion: Laparoscopic vaginalectomy is a safe and feasible way to deal with early stage recurrent cervical cancer.
789 Incidental Small Ovarian Surface Serous Carcinoma With Miliary Abdominal Seeding During Robotic-Assisted Total Hysterectomy Wang C-W, Chen C-H, Liu W-M. Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan Study Objective: To report a case in which incidental finding of extremely small ovarian surface tumor with abdominal miliary seeding during roboticassisted total hysterectomy. Design: Case report. Setting: University-affiliated teaching hospital. Patients: A 53 year-old women, Gravida 0 Para 0, who presented with dysmenorrhea and adenomyosis was admitted initially for robotic-assisted total hysterectomy. Intraoperatively, an incidental 0.5 cm right ovarian surface tumor noted with pelvic wall miliary tumors. Intraoperative frozen section revealed carcinoma both for ovarian tumor and pelvic