A case of endometrial stromal sarcoma treated with additional laparoscopic surgery using a wound from robot-assisted laparoscopic total hysterectomy

Yuichiro Kizaki, Kouki Samejima, Kosuke Shigematsu, Yoshiko Kurose, Takahiro Uotani, Shigetaka Matsunaga, Tomonori Nagai, Yasushi Takai
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2022 · vol. 38(1) , pp. 204–209 · doi:10.5180/jsgoe.38.1_204 · W4285301455
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A 45-year-old woman with uterine adenomyosis was diagnosed with low-grade endometrial stromal sarcoma after robot-assisted hysterectomy and underwent additional laparoscopic surgery via the initial incision.

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This case report describes a 45-year-old woman treated for excessive menstruation and uterine adenomyosis, who was incidentally diagnosed with low-grade endometrial stromal sarcoma following robot-assisted total hysterectomy. Pathological examination of the removed uterus revealed stage IA disease, prompting a decision to perform additional laparoscopic surgery to remove the remaining left ovary. The surgical team successfully utilized the incision from the initial robotic procedure for this secondary operation, reporting no complications or malignant findings in the excised tissue. This paper is centrally about endometriosis and adenomyosis — specifically, it details the clinical management and incidental discovery of malignancy in a patient initially presenting with uterine adenomyosis.

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Abstract

Endometrial stromal sarcoma, a rare disease, accounts for approximately 0.2％ of all types of uterine malignancies. The disease may be difficult to differentiate from the benign one using preoperative imaging and histological diagnosis. We report a case of a patient who underwent robot-assisted surgery for uterine adenomyosis and was diagnosed with low-grade endometrial stromal sarcoma. She underwent additional laparoscopic surgery using the initial surgical wound. A 45-year-old gravida 4, para 2 was referred because of excessive menstruation caused by uterine adenomyosis. Ultrasound and magnetic resonance imaging revealed uterine adenomyosis and a 5-cm right endometrioid ovarian cyst. Cytology did not reveal any suspicious findings for malignant disease. Hormone therapy was initiated, but bleeding and anemia were observed. Hence, robotic surgery was performed. Robot-assisted laparoscopic hysterectomy, right adnexectomy, and left tubectomy were performed using the da Vinci Xi system. The patient was discharged without any postoperative problems.
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症例報告 ロボット支援下腹腔鏡下子宮全摘術の創部を使用し腹腔鏡下に追加手術を施行した子宮内膜間質肉腫の１例 2022 年 38 巻 1 号 p. 204-209 詳細 抄録 Endometrial stromal sarcoma, a rare disease, accounts for approximately 0.2％ of all types of uterine malignancies. The disease may be difficult to differentiate from the benign one using preoperative imaging and histological diagnosis. We report a case of a patient who underwent robot-assisted surgery for uterine adenomyosis and was diagnosed with low-grade endometrial stromal sarcoma. She underwent additional laparoscopic surgery using the initial surgical wound. A 45-year-old gravida 4, para 2 was referred because of excessive menstruation caused by uterine adenomyosis. Ultrasound and magnetic resonance imaging revealed uterine adenomyosis and a 5-cm right endometrioid ovarian cyst. Cytology did not reveal any suspicious findings for malignant disease. Hormone therapy was initiated, but bleeding and anemia were observed. Hence, robotic surgery was performed. Robot-assisted laparoscopic hysterectomy, right adnexectomy, and left tubectomy were performed using the da Vinci Xi system. The patient was discharged without any postoperative problems. Pathological examination revealed low-grade endometrial stromal sarcoma, FIGO pT1a, NX, M0, stage IA. Based on the pathological diagnosis, laparoscopic removal of the left ovary was decided. The same wound as the initial surgery was used for the operation. No malignant findings were observed in the removed ovaries. When additional laparoscopic surgery was required after robot-assisted surgery, laparoscopic surgery using the previous wound was thought to be a safe option. © 2022 日本産科婦人科内視鏡学会

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