Fertility-sparing management of a suspicion of leiomyosarcoma: avoiding hysterectomy by performing transcervical myoma biopsy

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Authors:

Martha Duraes, M.D., Caroline Mandoul, M.D., Helene Perrochia, M.D., Gauthier Rathat, M.D. 

Abstract:

Objective

To describe the fertility-sparing management of an atypical uterine myoma.


Design

Step-by-step video explanation of transcervical biopsy using transabdominal ultrasound guidance, highlighting tips and tricks. Patient consent was obtained before the publication of the case.


Setting

University hospital.


Patient(s)

A 32-year-old nulliparous woman with a history of dysmenorrhea was found to have an atypical myoma FIGO 6, with suspicion of leiomyosarcoma on magnetic resonance imaging.


Intervention(s)

A transcervical biopsy of an atypical myoma was done under transabdominal ultrasound guidance. A myomectomy by a minimally invasive approach was performed without morcellation.


Main Outcome Measure(s)

Feasibility of transcervical biopsy and correlation with definitive anatomopathological diagnosis.


Result(s)

The patient was under general anesthesia. A hysteroscopy confirmed the normal appearance of the uterine cavity with no direct access to the myoma. Four core biopsies were performed with a 16-gauge needle transcervically under ultrasound guidance. The preliminary diagnosis of cellular leiomyoma allowed a fertility-sparing surgery. Myomectomy and surgical treatment of endometriosis were performed secondarily. This patient had a successful recovery, and the diagnosis of benign cellular leiomyoma was confirmed on the surgical specimen.


Conclusion(s)

The current video highlights the safety and feasibility of transcervical ultrasound-guided core biopsy in patients with atypical uterine fibroids.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.