Hystérectomies pour léiomyomes présumés : la crainte du léiomyosarcome doit-elle faire appréhender la voie d’abord chirurgicale autre que laparotomique ? |
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| Institution: | 1. Service de gynécologie-obstétrique, CHU Saint-Jacques, 2, place Saint-Jacques, 25030 Besançon, France;2. Service de gynécologie-obstétrique, CHG Belfort-Montbéliard, site de Belfort, 14, rue de Mulhouse, 90016 Belfort cedex, France;3. Service d’anatomie pathologique, CHG Belfort-Montbéliard, site de Belfort, 14, rue de Mulhouse, 90016 Belfort cedex, France;1. Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, CH-1211 Geneva 14, Switzerland;2. International Insulin Foundation, London, UK;3. Paris, France;4. International Union Against Tuberculosis and Lung Disease, Paris, France;5. University College London, London, UK;1. Department of Obstetrics and Gynecology, Rennes Hospital, Rennes University 1, Rennes, France;2. Université de Rennes 1, 2 Avenue de Professeur Léon Bernard, 35000, France;3. Department of radiology, Rennes Hospital, Rennes University 1, Rennes, France;1. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, CCC-1118 MCN, Nashville, TN 37232-2675, USA;2. Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1161 21st Avenue South, CCC-1118 MCN, Nashville, TN 37232-2675, USA;1. Service d''Hygiène, Epidémiologie et Prévention, Groupement hospitalier Edouard Herriot, Hospices Civils de Lyon, France;2. Equipe Epidémiologie et Santé Publique, Université de Lyon, Université Lyon 1, France;3. Service de Réanimation médicale, Groupement hospitalier Edouard Herriot, Hospices Civils de Lyon, France;4. Service Paludisme, Parasites du sang et Mycologie médicale, Groupement hospitalier Nord, Hospices Civils de Lyon, France;5. Service d''Hématologie, Groupement hospitalier Lyon Sud, Hospices Civils de Lyon, France |
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| Abstract: | ObjectivesThe presenting symptoms of leiomyosarcoma (LMS) are the same as those of leiomyoma. The diagnosis of LMS is usually achieved retrospectively after pathological analysis of hysterectomy specimens. The aim of surgery in uterine sarcomas being resection without tumor morcellation, LMS poses the problem of the choice of surgical route because it is more likely to occur in relatively young women. This study was undertaken to determine, firstly, the frequency of LMS in a series of hysterectomies performed for presumed leiomyomas, secondly, if there exist any particular context in which LMS should be considered and how this may modify the choice of surgical route, thirdly, to discuss about the therapeutical aspects of those cases of LMS diagnosed incidentally after uterine morcellation.Patients and methodsA retrospective review, from 1996 to 2005, of cases of LMS diagnosed retrospectively in patients having benefited from hysterectomy for presumed leiomyomas, at the department of Obstetrics-Gynaecology, Belfort Hospital.ResultsFrom 1996 to 2005, 1297 hysterectomies have been performed for presumed leiomyomas in our department. Patients’ mean age was 48 years (34 to 77 years). Menometrorraghia was the most common symptom having motivated surgery (57%), followed by pelvic pain (31%) and the notion of a rapidly growing uterine mass (12%). The distribution of surgical route was as follows: laparotomic route, n = 393 (30%); vaginal route, n = 855 (66%) and laparoscopic assisted vaginal route, n = 49 (4%). Pathological analysis had revealed LMS in three patients (0.23%).Discussion and conclusionLMS is usually diagnosed incidentally on hysterectomy specimen analysis. Indeed, the surgeon may find himself in a therapeutic dilemma in cases where vaginal extraction has required tumour morcellation with an increased risk of peritoneal and/or vaginal dissemination. However, given the extremely low incidence of LMS in series of hysterectomies performed for presumed leiomyomas and the lack of specific preoperative context to clearly evoke this diagnosis, the fear of leiomyosarcoma should not make us apprehend nonlaparotomic surgical routes. |
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