7554 Pneumoliner Containment System Using Power Morcellation: Case Report of Two Unexpected Uterine Malignancies

Abstract

<h3>Study Objective</h3> Few reports have documented the outcomes of uterine malignancies after power morcellation in a containment system. Here we describe two cases of an unexpected fibroid malignancy (Leiomyosarcoma and STUMP tumor) that was morcellated in a contained tissue extraction system. <h3>Design</h3> Case study. <h3>Setting</h3> University Hospital. <h3>Patients or Participants</h3> We present two cases: 35-year-old African American female with secondary dysmenorrhea and uterine fibroids and a 37-year-old Hispanic female with Abnormal Uterine Bleeding and uterine fibroids. <h3>Interventions</h3> Electromechanical morcellation (LINA) was introduced into a large containment system (PneumoLiner) during Laparoscopic tissue extraction. <h3>Measurements and Main Results</h3> The first case describes a 35-year-old patient that underwent a laparoscopic myomectomy for an intramural fibroid (8 cm) that was removed via power morcellation in a containment system. The pathology documented a multifocal Leiomyosarcoma within the Leiomyoma with a grossly intact bag. Two months after her myomectomy procedure, the patient underwent a Total Laparoscopic Hysterectomy and pathology confirmed no evidence of uterine malignancy with negative peritoneal washings. The second case describes a 37-year-old Hispanic female that underwent a laparoscopic myomectomy for multiple uterine fibroids (removal of 9 fibroids) that was removed via power morcellation in a containment system with a grossly intact bag. The patient underwent a Total Laparoscopic Hysterectomy 12 weeks after her myomectomy. Her final pathology confirmed a STUMP tumor, and the post-operative staging was negative. In both cases, the containment tissue extraction system was evaluated intraoperatively for bag rupture with a water-seal leak test and also sent to pathology for gross inspection. <h3>Conclusion</h3> The diagnosis of an unsuspected fibroid malignancy after a myomectomy is very rare, however may result in a worse prognosis if morcellated in an uncontained fashion. We report 2 cases of contained morcellation with fibroid malignancy with a 1-year follow-up.