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Risk of Occult Malignancy in Morcellated Hysterectomy: A Case Series

Hagemann, Ian S. M.D., Ph.D.; Hagemann, Andrea R. M.D.; LiVolsi, Virginia A. M.D.; Montone, Kathleen T. M.D.; Chu, Christina S. M.D.

International Journal of Gynecological Pathology: September 2011 - Volume 30 - Issue 5 - p 476–483
doi: 10.1097/PGP.0b013e3182107ecf

Uterine morcellation is performed only when significant neoplasia is not anticipated. In this study, we aimed to determine the prevalence of unexpected pathology in a series of low-risk morcellated hysterectomies. We reviewed a series consisting of all patients undergoing hysterectomy with morcellation at a tertiary-care hospital over a 4-yr period (n=101). Patient records were reviewed to retrieve demographics, details of preoperative evaluation (Pap smear, endometrial biopsy, imaging), and surgical pathology diagnoses. The median number of blocks submitted for histology was 6. On final pathology, endometrium was detected in 99% of all cases. No endometrial, myometrial, or cervical neoplasia other than leiomyoma (numerous cases) was present in the morcellated uteri, but in 1 case an atypical trophoblastic nodule with necrosis and myometrial infiltration, suspected to represent epithelioid trophoblastic tumor, was inadvertently morcellated. From this series, the prospective risk of occult malignancy in a low-risk population undergoing morcellation is estimated at 1% (95% confidence interval, <0.01%-5.94%). A subgroup analysis of patients who participated in what we propose as a complete preoperative workup, consisting of nonconcerning Pap smear, endometrial biopsy, and ultrasound or magnetic resonance imaging, showed no significant findings on final histology. Even with a complete workup, however, morcellation of occult uterine malignancy remains a possibility. This risk should be discussed as part of informed consent before morcellation.

Section of Surgical Pathology (I.S.H., V.A.L., K.T.M.), Department of Pathology and Laboratory Medicine

Division of Gynecologic Oncology (A.R.H., C.S.C.), Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA

No funding sources to disclose.

Address correspondence and reprint requests to Christina S. Chu, MD, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd., Philadelphia, PA 19104. e-mail:

©2011International Society of Gynecological Pathologists