Department of Obstetrics and Gynecology, Juntendo University Nerima Hospital, Tokyo, Japan.
J Minim Invasive Gynecol. 2012 Mar-Apr;19(2):252-4. doi: 10.1016/j.jmig.2011.10.012.
With widespread use of laparoscopy in patients with gynecologic malignancy, occasionally port-site metastasis is an item of concern. Herein we report a case of leiomyosarcoma of the uterus that metastasized to an accessory port after laparoscopic-assisted vaginal hysterectomy. A 46-year-old woman with a preoperative diagnosis of leiomyoma underwent laparoscopic-assisted vaginal hysterectomy. Final histopathologic findings revealed leiomyosarcoma. A postoperative abdominopelvic computed tomography scan demonstrated no evidence of metastatic tumor. The patient received 6 courses of combined chemotherapy consisting of cisplatin and ifosfamide. Follow-up computed tomography was performed because of pelvic pain at 4 months after treatment and revealed a recurrent pelvic tumor and a metastatic mass at previous right trocar site. At debulking surgery, a pelvic mass measuring 10 cm was observed, and a subcutaneous nodule measuring 4 cm was noted at the site of the right accessory port, with intact underlying peritoneum. After complete removal of both tumors, concurrent chemoradiation consisting of external radiotherapy and cisplatin was administered. Six months after the second surgery, a pelvic mass measuring 15 cm was observed. A second debulking surgical procedure was performed. However, the patient died of the disease 6 months after the second recurrence.
随着腹腔镜在妇科恶性肿瘤患者中的广泛应用，偶尔会出现切口部位转移的问题，引起关注。本文报告了一例子宫平滑肌肉瘤经腹腔镜辅助阴道子宫切除术发生辅助切口转移的病例。一名 46 岁女性，术前诊断为子宫肌瘤，行腹腔镜辅助阴道子宫切除术。最终的组织病理学检查结果显示为平滑肌肉瘤。术后腹部盆腔 CT 扫描未见转移性肿瘤证据。患者接受了 6 个周期的顺铂和异环磷酰胺联合化疗。治疗后 4 个月因盆腔疼痛进行随访 CT 检查，显示复发性盆腔肿瘤和先前右侧 trocar 部位的转移性肿块。在肿瘤细胞减灭术时，观察到一个 10 cm 的盆腔肿块，在右侧辅助切口部位观察到一个 4 cm 的皮下结节，其下的腹膜完整。在完全切除两个肿瘤后，给予包括外照射和顺铂的同步放化疗。第二次手术后 6 个月，观察到一个 15 cm 的盆腔肿块。进行了第二次肿瘤细胞减灭术。然而，该患者在第二次复发后 6 个月死于该疾病。
