Examination of tumor samples obtained after laparoscopic supracervical hysterectomy and a derivative leiomyosarcoma. Homo sapiens

Unexpected malignant tumors are a rare finding after surgery for symptomatic leiomyomas but there is little doubt that morcellation of these lesions is associated with a higher risk of iatrogenic peritoneal spread compared to women having surgery without morcellation. Thus, the FDA has issued a warning against the use of power morcellation in the majority of women undergoing myomectomy or hysterectomy for treatment of fibroids.We pressent a case report of 50year old patient with intervertebral disc degeneration and multiple uterine fibroids decided to have laparoscopic supracervical hysterectomy. 28 months later the patient cystic adnexal massas removed by laparotomy and histologically, classified as leiomyosarcoma. 19 months after this latter surgery MRI revealed a 10 x 8 x 6 cm abdominal mass attached to the liver and numerous other nodules attached to the abdominal wall. We investigated genomic and expression profiles of four samples obtained from initial surgery and the malignant tumor that appeared 16 month later by molecular inversion probe (MIP) and transcriptome array hybridization. DNA was extracted from FFPE Tissue Samples using Covaris adaptive focused acoutics (AFATM) and truXTRACTM FFPE DNA kit and subjected to array analysis using the Affymetrix OncoScan and human Clariom D platforms according to the manufacturers protocol. Overall design: Four morcellated specimens of a 50 year old patient with multiple uterine fibroids and a leiomyosarcoma removed 28 later were investigated by molecular inversion probe (MIP) array and transcriptome array analysis. The aim of the study was to investigate if the leiomyosarcoma had developed from one of the leiomyomas as a result of secondary genetic alterations and to compare the expression profiles of the tumors.

因症状性平滑肌瘤（leiomyomas）行手术后偶然检出恶性肿瘤的情况较为罕见，但毋庸置疑，与未接受肌瘤粉碎术的患者相比，对这类病变组织进行粉碎术会显著升高医源性腹膜播散风险。因此，美国食品药品监督管理局（FDA）已发布警告，禁止在多数接受肌瘤切除术（myomectomy）或子宫切除术（hysterectomy）以治疗子宫肌瘤（uterine fibroids）的女性患者中使用电动粉碎术（power morcellation）。本文报道1例50岁女性患者，该患者合并椎间盘退变与多发性子宫肌瘤，拟行腹腔镜宫颈上子宫切除术（laparoscopic supracervical hysterectomy）。术后28个月，患者因囊性附件肿块接受剖腹手术，经组织病理学检查确诊为平滑肌肉瘤（leiomyosarcoma）。该后续手术后19个月，核磁共振成像（MRI）显示患者存在1枚10×8×6cm的腹部肿块，附着于肝脏，同时腹壁可见多发结节。本研究对首次手术获取的4份样本以及16个月后出现的恶性肿瘤样本，采用分子倒置探针（molecular inversion probe, MIP）技术与转录组芯片杂交技术开展基因组与表达谱分析。采用Covaris自适应聚焦声波（AFA™）系统与truXTRACT™ FFPE DNA提取试剂盒从福尔马林固定石蜡包埋（FFPE）组织样本中提取DNA，并依照制造商的实验方案，使用Affymetrix OncoScan芯片与人类Clariom D芯片平台进行芯片分析。整体实验设计：对1名50岁多发性子宫肌瘤患者的4份肌瘤粉碎标本以及术后28个月切除的平滑肌肉瘤样本，开展分子倒置探针（MIP）芯片与转录组芯片分析。本研究旨在探究平滑肌肉瘤是否由其中某枚平滑肌瘤经继发遗传学改变进展而来，并对比不同肿瘤的表达谱特征。