Morcellation at the time of minimally invasive hysterectomy or myomectomy for presumed benign indications carries a risk of disseminating undiagnosed uterine malignancies.
A 57-year-old woman with a remote history of laparoscopic hysterectomy with morcellation of a cellular leiomyoma presented with a newly diagnosed complex pelvic mass. Owing to adherence of the mass to the rectum and numerous peritoneal tumor implants, a surgical cytoreductive procedure was performed. The pelvic mass, implants, and original hysterectomy specimen were histologically identical and consistent with low-grade endometrial stromal sarcoma. Owing to lack of tumor–myometrial interface on the original morcellated specimen, this malignant diagnosis was not made at the time of hysterectomy.
Morcellation of the uterus can hinder an accurate pathologic diagnosis of uterine stromal neoplasms.