Vaginal Mucosal Implantation After Total Laparoscopic Hysterectomy for an Early Stage Endometrial Cancer

Abstract

We present an extremely rare case of vaginal implantation of endometrial cancer, which is presumed to have been caused by transvaginal uterine removal during laparoscopic hysterectomy. A 48-year-old woman, nulligravida, had had a bilateral salpingo-oophorectomy due to benign mature cystic teratoma at 46 years old. She presented abnormal genital bleeding and had a total laparoscopic hysterectomy, due to stage Ia endometrial cancer. Postoperative pathology revealed an endometrioid adenocarcinoma G1, showing myometrial invasion, not exceeding the half of the muscular layer. The vascular space invasion and lymphatic space invasion were markedly recognized. Three cycles of combination chemotherapy with paclitaxel and carboplatin, with an interval of 3 weeks, have been postoperatively executed. Four months after the completion of adjuvant chemotherapy, a gross tumor of 6 mm in diameter was found at left vaginal mucosa near hymen. Vaginal biopsy of the lesion revealed a serous adenocarcinoma, and review of the primary endometrial tumor concluded that the primary endometrial carcinoma is corrected to a diagnosis of serous adenocarcinoma. It is considered that the vaginal lesion have been implanted through transvaginal uterine removal during the laparoscopic surgery. The vaginal lesion was surgically resected, however, during the follow-up examination, the other undifferentiated sarcoma was detected at right lung and the treatment was focused on to the sarcoma. And the patient died of the sarcoma, without the further recurrence of endometrial cancer.




J Clin Gynecol Obstet. 2018;7(2):57-61
doi: https://doi.org/10.14740/jcgo495w