Introduction/Background*Inflammatory myofibroblastic tumours (IMT) are rare spindle cell neoplasms of indeterminate malignant potential, commonly found in the lungs, but also originating from various organs ranging from head and neck, gastrointestinal to the genitourinary system. IMTs of the female gynaecological tract are rare and may mimic benign leiomyoma in both clinical presentation and appearance on imaging. We describe a case of uterine IMT, diagnosed after a laparoscopic myomectomy with in-bag morcellation.
Result(s)*A 37-year-old woman was on follow-up for uterine mass on pelvic ultrasound, slowly enlarging to 3.3cm, presumed to be a fibroid. Although she did not have significant pressure symptoms or menorrhagia, she requested for removal and underwent laparoscopic myomectomy with morcellation-in-bag.
Intra-operatively, a 6cm mass was seen on the uterine posterior wall, macroscopically and morphologically consistent with that of benign leiomyoma. However, immunohistochemistry and molecular sequencing were positive for ALK-1 hence a diagnosis of IMT was made. Diffuse staining for desmin, H-caldesmon and ER was also noted. Following a multi-disciplinary tumour board, consensus was for a CT scan of the thorax, abdomen and pelvis(which showed no extra-uterine spread) and for regular surveillance scans.
A review of the literature shows no universal consensus as to optimal treatment of uterine IMT. Majority of cases have been treated with surgical excision – open, laparoscopic or hysteroscopic. While most cases have a benign course with no recurrence/relapse, local recurrences are a known complication.
Given controversies in recent years over power morcellation potentially leading to dissemination of undiagnosed uterine leiomyosarcomas, morcellation-in-bag has become standard practice for all laparoscopic myomectomies or hysterectomies requiring morcellation. There is little data regarding outcomes of other types of uterine tumours, or IMT specifically, with regards to outcomes following morcellation. The only two documented cases in the literature specifically involving morcellation resulted in local recurrences requiring further treatment.
Conclusion*We present a case of uterine IMT diagnosed following laparoscopic myomectomy and in-bag morcellation. While the patient has no sign of extrauterine spread at present, further follow-up will be required to monitor for any progression or recurrence. Outcomes following morcellation or specific other treatment options will need to be further studied.
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