骨盤内再発した低悪性度子宮内膜間質肉腫に対して腹腔鏡下摘出術を施行した1例

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  • Laparoscopic Resection for Recurrent Pelvic Disseminations of a Low Grade Endometrial Stromal Sarcoma: Case Report

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A low grade endometrial stromal sarcoma (LGESS) is characterized by slow progression and late recurrence; therefore, it is important to manage recurrent disease with surgery and progestin therapy. We report a case treated by laparoscopic surgery for pelvic disseminations of a LGESS. A 49-year-old woman underwent a vaginal hysterectomy for uterine fibroids seven years ago; it was pathologically diagnosed as a LGESS postoperatively. She refused both a re-operation, including bilateral salpingo-oophorectomy, and adjuvant hormone therapy. Almost seven years after the surgery, she underwent video-assisted thoracic surgery (VATS) on two occasion for excision of multiple pulmonary nodules; she also received high dose medroxyprogesterone acetate therapy (600 mg/day). Subsequently, new metastatic pulmonary nodules and pelvic cystic masses, which were suspicious for metastatic disease of the ovaries appeared. We strongly recommended surgery. At surgery, both ovaries had a normal appearance; however, there were several disseminated nodules near the vaginal stump. All these tumors did not deeply invade the intraperitoneal space; therefore, we could readily and completely remove them without any intra-operation adverse events. Postoperative histology revealed recurrence of a LGESS to the pelvis and both adnexa. Presently at approximately postoperative 12 months, no postoperative complication has been reported with the remaining lung nodule showing a decreasing tendency. We conclude that complete surgical excision has a potent effect on LGESS, even for recurrent tumors. Furthermore, laparoscopic surgery is recommended because it is a less invasive procedure with a lower risk of postoperative complications.

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