1
|
Li Z, Zhou G, Duan S, Li Q. Primary clear cell adenocarcinoma of the rectovaginal septum: A rare case report. Medicine (Baltimore) 2023; 102:e33285. [PMID: 36930116 PMCID: PMC10019212 DOI: 10.1097/md.0000000000033285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
RATIONALE Primary clear cell adenocarcinoma of the rectovaginal septum is a very rare event. PATIENT CONCERNS We reported a case of a 55-year-old woman diagnosed with a lump in the vaginal rectal septum after undergoing hysterectomy with bilateral salpingo-oophorectomy in 2017, who was admitted to our department due to vaginal bleeding. Magnetic resonance imaging of the pelvis indicated the vaginal rectal space cystic and solid mass about 110 mm × 100 mm × 140 mm in size. DIAGNOSIS The pathological diagnosis of postoperative was clear cell adenocarcinoma. INTERVENTIONS Abdominal laparotomy showed a solid block of the vaginal rectal septum. Surgery was performed to reduce the tumor. OUTCOMES This patient received 8 courses of combined chemotherapy courses after surgery for the residual lesion and achieved a complete response. LESSONS Due to the rare observation of the growth pattern, the cell morphology and immune phenotype are not specific, and clinical and pathological diagnosis is difficult. Introducing the diagnosis and treatment of this case and reviewing the literature provide a relevant reference for clinicians identification and diagnosis and treatment of this rare case.
Collapse
Affiliation(s)
- Zhifang Li
- Obstetrics and Gynecology, Anqing Municipal Hospital, Anqing, China
| | - Guiju Zhou
- Obstetrics and Gynecology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shuqiang Duan
- Obstetrics and Gynecology, Anqing Municipal Hospital, Anqing, China
| | - Qing Li
- Obstetrics and Gynecology, Anqing Municipal Hospital, Anqing, China
| |
Collapse
|
2
|
Onishi T, Amano T, Miyake T, Nakamura A, Yoneoka Y, Nisimura H, Tsuji S, Tani M, Murakami T. Transanal total mesorectal excision for primary rectovaginal carcinosarcoma: A case report and literature review. J Obstet Gynaecol Res 2023; 49:763-768. [PMID: 36369664 DOI: 10.1111/jog.15487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/15/2022]
Abstract
We report a case of rectovaginal septum carcinosarcoma successfully treated with surgical excision via transanal total mesorectal excision following platinum-based neoadjuvant chemotherapy. A 48-year-old woman presented with a 3-week defecation pain preceding the visit. Pelvic imaging showed an 8-cm sized lesion in the lower rectovaginal septum. Transvaginal biopsy and immunohistochemical analysis were performed. After three courses of carboplatin-paclitaxel-bevacizumab therapy, the mass reduced by half. Subsequently, laparoscopic excision with transanal total mesorectal excision, and radical hysterectomy were performed. The anus was preserved, and dysuria improved within a month. The final histopathological diagnosis was carcinosarcoma of the rectovaginal septum from an uncertain origin, presumably endometriotic or mesonephric. Twelve months following surgery, solitary liver metastasis was confirmed; however, there was no evidence of local recurrence. Total mesorectal excision following platinum-based neoadjuvant chemotherapy may be an ideal treatment for gynecological malignancies in the rectovaginal septum, especially for large tumors localized deep into the pelvis.
Collapse
Affiliation(s)
- Takuto Onishi
- Department of Obstetrics and Gynecology, Omihachiman Community Medical Center, Omihachiman, Shiga, Japan
| | - Tsukuru Amano
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Akiko Nakamura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Yutaka Yoneoka
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Hiroki Nisimura
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| |
Collapse
|
3
|
Saavalainen L, Lassus H, But A, Gissler M, Heikinheimo O, Pukkala E. Incidence of extraovarian clear cell cancers in women with surgically diagnosed endometriosis: A cohort study. PLoS One 2021; 16:e0253270. [PMID: 34185779 PMCID: PMC8241117 DOI: 10.1371/journal.pone.0253270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endometriosis is associated with increased risk of clear cell ovarian cancer and has even suggested being an etiological factor for this cancer. Association between endometriosis and extraovarian clear cell cancers is unclear. This study aimed to assess the association between surgically diagnosed endometriosis and risk of extraovarian clear cell cancers according to the type of endometriosis (i.e., ovarian, peritoneal, and other endometriosis) and the site of clear cell cancer. METHODS In this register-based historic cohort study we identified all women with surgically diagnosed endometriosis from the Finnish Hospital Discharge Registry 1987-2012. Data on extraovarian clear cell cancers of these women were obtained from the Finnish Cancer Registry. The follow-up started January 1st, 2007 or at endometriosis diagnosis (if later), and ended at emigration, death or on the December 31st, 2014. Standardized incidence ratios were calculated for each site of clear cell carcinoma (intestine, kidney, urinary tract, gynecological organs other than ovary), using the Finnish female population as reference. RESULTS The endometriosis cohort consisted of 48,996 women, including 22,745 women with ovarian and 19,809 women with peritoneal endometriosis. Altogether 23 extraovarian clear cell cancers were observed during 367,386 person-years of follow-up. The risk of extraovarian clear cell cancer was not increased among all women with surgically diagnosed endometriosis (standardized incidence ratio 0.89, 95% confidence interval 0.56-1.33) nor in different types of endometriosis. The incidence of clear cell cancer in any specific site was not increased either. CONCLUSIONS The risk of extraovarian clear cell cancers in women with surgically diagnosed endometriosis is similar to that in the general population in Finland.
Collapse
Affiliation(s)
- Liisu Saavalainen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heini Lassus
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna But
- Department of Public Health, Biostatistics Consulting, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Eero Pukkala
- Finnish Cancer Registry–Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| |
Collapse
|
4
|
Fujimoto T, Tanuma F, Otsuka N, Kataoka S. Laparoscopic posterior pelvic exenteration for primary adenocarcinoma of the rectovaginal septum without associated endometriosis: A case report. Mol Clin Oncol 2019; 10:92-96. [PMID: 30680193 DOI: 10.3892/mco.2018.1751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/23/2018] [Indexed: 11/06/2022] Open
Abstract
The present report describes a case of laparoscopic posterior pelvic exenteration of a primary adenocarcinoma of the rectovaginal septum (PARS) without associated endometriosis. A 49-year-old woman was admitted to hospital for rectal bleeding. Imaging studies showed a 7-cm solid tumor located in the rectovaginal septum, presenting with invasion to the posterior aspect of the uterine cervix and the anterior rectal wall. The patient received laparoscopic posterior exenteration and rectosigmoid anastomosis followed by chemotherapy. There were no intra- or post-operative complications. Histopathological examination of the neoplastic tissue revealed moderate to severe cytological atypia with bizarre multinucleated cells and prominent mitotic figures. Histopathologically, R0 resection was achieved. No endometriotic lesions were confirmed in the primary tumor or other removed tissues. Immunohistochemistry showed positive staining for cytokeratin (CK)7, cancer antigen 125, vimentin, estrogen receptor and p53, but negative staining for CK20, progesterone receptor, p40 and thyroid transcription factor 1. Based on these findings and on the location of the tumor, the neoplasm was diagnosed as PARS without associated endometriosis, which may have arisen from metaplasia of the embryological Müllerian-duct remnants.
Collapse
Affiliation(s)
- Toshio Fujimoto
- Department of Obstetrics and Gynecology, Tomakomai City Hospital, Tomakomai, Hokkaido 053-8567, Japan
| | - Fumie Tanuma
- Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Hokkaido 040-8585, Japan
| | - Noriyuki Otsuka
- Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Soromon Kataoka
- Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Hokkaido 040-8585, Japan
| |
Collapse
|
5
|
Affiliation(s)
- Debra S. Heller
- Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ
| |
Collapse
|
6
|
Lopez N, Grabowski JP, De Santiago J, Zapardiel I. Carcinoma of the recto-vaginal septum. Comprehensive literature review. J OBSTET GYNAECOL 2015; 36:450-4. [PMID: 26467428 DOI: 10.3109/01443615.2015.1065234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Carcinoma of the recto-vaginal septum is an extremely rare entity. We performed a MEDLINE-based search on recto-vaginal septum carcinoma, focussing on its management, in order to clarify which are the best treatment options for this disease. In addition an unpublished case report has been added to the review. 34 case reports were included in our review. Surgery and adjuvant chemoradiation therapy seem to be the most common treatment option. However, since primary surgical treatment leads to mutilation by removing a large portion of the vagina and the anal sphincter with a permanent terminal colostomy, primary platinum-based chemoradiation therapy could be considered. In case of extragastrointestinal stromal tumours primary surgical treatment seems to be the best option. Due to the rarity of this entity only limited data is available. Therefore further investigation is necessary.
Collapse
Affiliation(s)
- N Lopez
- a Department of Gynaecological Oncology , La Paz University Hospital , Madrid , Spain
| | - J P Grabowski
- b Department of Gynecology , European Competence Center for Ovarian Cancer, Charité-University Medicine of Berlin , Berlin , Germany
| | - J De Santiago
- a Department of Gynaecological Oncology , La Paz University Hospital , Madrid , Spain
| | - I Zapardiel
- a Department of Gynaecological Oncology , La Paz University Hospital , Madrid , Spain
| |
Collapse
|
7
|
Mabuchi S, Kawano M, Isohashi F, Kuroda H, Sasano T, Kimura T. First two cases of primary carcinoma of the vagina successfully treated with concurrent weekly carboplatin plus paclitaxel, external beam radiotherapy and high-dose-rate interstitial brachytherapy: A case report and published work review. J Obstet Gynaecol Res 2015; 41:156-61. [DOI: 10.1111/jog.12492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Seiji Mabuchi
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Mahiru Kawano
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Hiromasa Kuroda
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Tomoyuki Sasano
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology; Osaka University Graduate School of Medicine; Suita Osaka Japan
| |
Collapse
|
8
|
Mabrouk M, Vicenzi C, Ferrini G, Geraci E, Forno SD, Caprara G, Montanri G, Seracchioli R. Mixed adenocarcinoma of the rectovaginal septum associated with endometriosis and endometrial carcinoma: a case report. Case Rep Oncol 2011; 4:149-54. [PMID: 21691574 PMCID: PMC3114620 DOI: 10.1159/000326067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose To present a case of primary mixed (clear cell and endometrioid type) adenocarcinoma of the rectovaginal septum, probably arising from endometriosis and associated with a highly differentiated, early-stage endometrioid endometrial carcinoma. The case was managed by a minimally invasive approach and postoperative adjuvant chemotherapy. Results The patient underwent clinical/instrumental follow-up and a second-look laparoscopy after the primary surgery as well as adjuvant chemotherapy. No evidence of disease could be observed after the treatment. Conclusion Surgery with postoperative chemotherapy can be recommended for the treatment of mixed adenocarcinoma of the rectovaginal septum.
Collapse
Affiliation(s)
- Mohamed Mabrouk
- Minimally Invasive Gynecological Surgery Unit, Department of Gynaecology, Bologna University, Bologna, Italy
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Takemoto S, Ushijima K, Nakaso K, Fujiyoshi N, Kamura T. Primary adenocarcinoma of the vagina successfully treated with neoadjuvant chemotherapy consisting of paclitaxel and carboplatin. J Obstet Gynaecol Res 2009; 35:579-83. [DOI: 10.1111/j.1447-0756.2008.00979.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|