Suspected malignant transformation of adenomyosis based on postoperative histopathological diagnosis after laparoscopic hysterectomy: A case report

Shinichi Hoshi, Tomoko Tanaka, Takashi Hara, Kumiko Sakai, Megumi Shibata, Shōichi Watanabe, Tsutomu Araki, Shigeo Akira
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2020 · vol. 36(2) , pp. 235–240 · doi:10.5180/jsgoe.36.2_235 · W3127197481
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This case report describes a patient who underwent total laparoscopic hysterectomy for uterine adenomyosis and was subsequently diagnosed with endometrial cancer.

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This case report describes a 45-year-old woman who underwent total laparoscopic hysterectomy for dysmenorrhea after a preoperative diagnosis of uterine adenomyosis, with no abnormal bleeding or endometrial thickening noted preoperatively. Postoperative histopathological examination led to a diagnosis of endometrioid adenocarcinoma, raising concern for malignant transformation after the surgery. The authors note that published literature suggests the malignant transformation rate of uterine adenomyosis is comparable to that of ovarian chocolate cysts, and emphasize that early detection is difficult, with laparoscopic surgery potentially contributing to dissemination of malignant cells. This paper is centrally about adenomyosis — specifically, a suspected malignant transformation to endometrioid adenocarcinoma diagnosed on postoperative pathology after laparoscopic hysterectomy.

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Abstract

Total laparoscopic hysterectomy is increasingly being performed for uterine adenomyosis following widespread use of laparoscopic surgery in clinical practice. We report a case of postoperative endometrial cancer following total laparoscopic hysterectomy performed for uterine adenomyosis.
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症例報告 子宮腺筋症の診断で腹腔鏡下子宮全摘手術を行い、術後病理診断にて子宮腺筋症の悪性転化が疑われた1例 2020 年 36 巻 2 号 p. 235-240 詳細 抄録 Total laparoscopic hysterectomy is increasingly being performed for uterine adenomyosis following widespread use of laparoscopic surgery in clinical practice. We report a case of postoperative endometrial cancer following total laparoscopic hysterectomy performed for uterine adenomyosis. A 45-year-old woman underwent total laparoscopic hysterectomy for dysmenorrhea. No abnormal bleeding or endometrial thickening was observed preoperatively; however, she was diagnosed with endometrioid adenocarcinoma based on postoperative histopathological examination. Studies in the available literature have reported that the rate of malignant transformation of uterine adenomyosis is the same as that observed in cases of ovarian chocolate cysts. Early detection of malignant transformation of uterine adenomyosis is challenging. Notably, laparoscopic surgery may result in dissemination of malignant cells; therefore, accurate preoperative diagnosis and careful management are important in these patients considering potential malignant transformation. © 2020 日本産科婦人科内視鏡学会

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adenomyosis

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