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Tumor Discovery Surgical implantation of malignant cells

to match the incidence of abdominal scar recurrences in on surrounding organs), in which eight of 15 reports had
open colectomy . been published between 2004 and 2009. Eleven out of
[25]
16 patients had a past history of surgery, which involved
4.7. Cutaneous metastasis electric morcellator in six cases and some unspecified
Cutaneous metastasis of internal malignancy is a rare form of morcellation in the other five cases. The majority
[44]
event with incidence rates ranging from 1.0% to 4.6% . of the parasitic myomas were found in the pelvis but three
Metastasis usually develops at the umbilicus, in surgical were located in the upper right quadrant near the liver
scars, at laparoscopic port sites, and near metastatic lymph and gallbladder. Nezhat and Kho also recorded at least five
nodes. However, the most common source of dermal reports of leiomyomatosis peritonealis disseminata (LPD)
metastasis in the face and neck is oral cavity cancer . occurring in association with laparoscopic myomectomy
[45]
A retrospective study on patients who had been subjected and the use of morcellators. LPD is a rare benign condition
to excision of primary tumor and neck dissection and characterized by multiple smooth muscle myofibroblastic
then developed skin metastasis revealed that previous and fibroblastic nodules on the peritoneal surfaces of pelvic
skin involvement, extracapsular extension of metastatic and abdominal cavities on the surface of the uterus, intestines
nodes, and indication for chemotherapy are predictors of and abdominal walls. Based on the findings of these reports,
dermal metastasis, irrespective of stage . These cutaneous the parasitic myomas are christened “iatrogenic myomas.”
[46]
[53]
metastasis are painless, solitary, or multiple nodules The Clinical Practice Guidelines reviewed by Gynecology
separate from the overlying epidermis and distinct from Guideline Management and Oversight Committees and
direct skin invasion . Other cutaneous metastasis can the Executive of the Society of Gynaecologic Oncology of
[47]
be divided into metastatic umbilical tumors or Sister Canada (GOC) recommend that:
Mary Joseph nodules (SJNs) and non-SJN metastasis. The (1) Morcellation is contraindicated in established cancer,
non-SJN metastases are further subdivided into those pre-cancerous lesions, or suspected cancer.
occurring due to surgery, injury, or lymphadenopathy. (2) Patients should be counseled about the risks (malignant
In non-SJNs, direct implantation, hematogenous spread, and non-malignant), benefits, and alternatives as part
and extranodal extension play a key role. Thereafter, the of informed consent.
tumor cells hinge on the factors involved in wound healing (3) Morcellation should be avoided in hereditary cancer
and inflammation for proliferation . An unusual case syndromes that predispose to uterine malignancies.
[44]
of metastasis of adenocarcinoma of the colon to the skin 4.9. Present-day beliefs and practices
of the right groin, scrotum, and perineum presenting as
erythema, papules, and fake blisters has been reported , Early in 1937, an editorial published in The New England
[48]
stating that Koebner phenomena maybe involved. Journal of Medicine made a mention regarding the search
for tumor cells on surgical knives used for the surgery
4.8. Iatrogenic myoma of malignant tumors . This had then been reiterated by
[8]
[20]
When uterine leiomyomas (“fibroids”) are treated with Curran et al. in 1996 . A prospective study of the gloves
laparoscopic myomectomy or sub-total hysterectomy, the and instruments used in head-and-neck cancer surgeries
tumor must be cut into pieces or morcellated to enable found cells in all washings.
extraction. If a power morcellator, which cuts the tumor into Yu et al. attempted to study each surgical supply
cores of 1 cm diameter, is used, there will be intraperitoneal separately in patients undergoing D2 resection for gastric
dispersal of microscopic tumor fragments. The first few cancers . Surgical supplies were divided into five groups:
[54]
cases regarding this have been reported in 2003 and (i) Surgical instruments; (ii) surgical gloves of the surgeon,
[49]
2005 , documenting intraperitoneal dissemination of first assistant, and second assistant; (iii) surgical gloves
[50]
endometrial tissue visualized by means of post-operative and gauze used by the scrub nurse; (iv) gauze used to clear
histopathology. Seidman et al. investigated 1091 operative field; and (v) stapler devices. The immersion
[51]
instances of morcellation and found leiomyoma variants fluid was centrifuged and the precipitate was cultured in
or atypical and malignant smooth muscle tumors in 1.2% 20% bovine fetal serum with 5% carbon dioxide. Although
cases, including endometrial stromal sarcoma, cellular exfoliated cells were found in all five groups of supplies,
leiomyoma, atypical leiomyoma, smooth muscle tumor they were most frequent in the gloves and gauze used by
of uncertain potential (STUMP), and leiomyosarcoma. the scrub nurse and the gauze used to clear the operative
Moreover, they documented disseminated disease in field. Many authors have recommended that surgical
64.3% of all tumors. Nezhat and Kho reviewed reports instruments and drapes be changed when moving from
[52]
of parasitic myomas (pedunculated myomas that have one anatomical field to another, for example, from site of
lost their attachment to the uterus and become parasitic resection to site of harvest of flap. They also suggested that

Volume 2 Issue 3 (2023) 6 https://doi.org/10.36922/td.1411