Ovarian endometrioid carcinoma detected 3 months after total laparoscopic hysterectomy: A case report

Takeshi Nakayama, Toshiya Itoh, Takahiro Suzuki, Mari Mukai, Aki Mukai, Ayako Oda, Toshiaki SHIBATA, Hiroaki Itoh
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2020 · vol. 36(2) , pp. 253–257 · doi:10.5180/jsgoe.36.2_253 · W3128468344
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A 50-year-old woman with concurrent adenomyosis and endometriosis developed ovarian endometrioid carcinoma three months after total laparoscopic hysterectomy, despite the initial appearance of a normal right ovary.

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This case report describes a 50-year-old patient who underwent total laparoscopic hysterectomy and left salpingo-oophorectomy for uterine fibroids, adenomyosis, and suspected benign ovarian tumor. Intraoperative observation of endometriosis prompted the removal of the left ovary, while the right ovary appeared normal at that time. Three months post-surgery, imaging revealed a rapidly enlarging pelvic mass, which was surgically resected and diagnosed as grade 1 ovarian endometrioid carcinoma. The authors note that preoperative GnRH agonist therapy may have masked the malignancy, leading to a delayed diagnosis despite the rare nature of such rapid progression. Relevance to endometriosis: This paper is centrally about endometriosis, noting its presence in the surgical field and its potential association with the subsequent development of endometrioid carcinoma.

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Abstract

[Case] A 50-year-old gravida 2, para 1 presented with multiple fibroids and a right ovarian tumor. Magnetic resonance imaging (MRI) revealed multiple uterine fibroids and a right ovarian tumor (4 cm) without any signs suggestive of malignancy. We performed total laparoscopic hysterectomy (TLH) after completion of 6 courses of gonadotropin-releasing hormone (GnRH) agonist therapy. Intraoperatively, we observed endometriosis around Douglas' pouch and the left adnexa; therefore, we performed simultaneous left salpingo-oophorectomy. The right ovary appeared normal in size. Postoperative histopathological examination revealed uterine fibroids and adenomyosis, and the left ovary showed no neoplastic lesions. Transvaginal ultrasonography performed at her 3-month postoperative follow-up revealed an enlarged right pelvic tumor (5 cm). MRI findings were suspicious for cancer, such as gastrointestinal stromal tumor. Therefore, a gastrointestinal surgeon performed concurrent laparotomy. The edematous pelvic tumor measured 9 cm in size with peripheral adhesions. We performed resection of the pelvic tumor and pelvic lymph node sampling (operation time 129 min, estimated blood loss 590 mL). Ascites fluid cytology evaluation showed negative results. Histopathological examination confirmed the diagnosis of ovarian endometrioid carcinoma G1. The patient received 6 courses of postoperative dose-dense paclitaxel-carboplatin therapy uneventfully, and no recurrence has occurred to date.
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症例報告 腹腔鏡下子宮全摘後3ヶ月で発見された卵巣類内膜癌の1例 2020 年 36 巻 2 号 p. 253-257 詳細 抄録 [Case] A 50-year-old gravida 2, para 1 presented with multiple fibroids and a right ovarian tumor. Magnetic resonance imaging (MRI) revealed multiple uterine fibroids and a right ovarian tumor (4 cm) without any signs suggestive of malignancy. We performed total laparoscopic hysterectomy (TLH) after completion of 6 courses of gonadotropin-releasing hormone (GnRH) agonist therapy. Intraoperatively, we observed endometriosis around Douglas' pouch and the left adnexa; therefore, we performed simultaneous left salpingo-oophorectomy. The right ovary appeared normal in size. Postoperative histopathological examination revealed uterine fibroids and adenomyosis, and the left ovary showed no neoplastic lesions. Transvaginal ultrasonography performed at her 3-month postoperative follow-up revealed an enlarged right pelvic tumor (5 cm). MRI findings were suspicious for cancer, such as gastrointestinal stromal tumor. Therefore, a gastrointestinal surgeon performed concurrent laparotomy. The edematous pelvic tumor measured 9 cm in size with peripheral adhesions. We performed resection of the pelvic tumor and pelvic lymph node sampling (operation time 129 min, estimated blood loss 590 mL). Ascites fluid cytology evaluation showed negative results. Histopathological examination confirmed the diagnosis of ovarian endometrioid carcinoma G1. The patient received 6 courses of postoperative dose-dense paclitaxel-carboplatin therapy uneventfully, and no recurrence has occurred to date. [Summary] Ovarian endometrioid carcinoma rarely shows rapid progression. Preoperative GnRH analogue administration might mask ovarian endometrioid cancer. © 2020 日本産科婦人科内視鏡学会

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