abstract
OBJECTIVE:
Ovarian cancer laparoscopic staging of patient with intraperitoneal renal transplant.
METHODS:
43-year-old
female with intra-peritoneal renal transplant was referred status post
laparoscopic bilateral ovarian cystectomies. The pathology report
revealed
serous adenocarcinoma with clear cell and papillary features of
ovaries and endometrium. She was asymptomatic with benign examination.
PET/CT of chest/abdomen/pelvis showed area of metabolic activity in left
ovary and right common iliac pelvic lymph nodes.
RESULTS:
During
laparoscopic staging Nezhat et al. (2009 Jan 31) [1], the
intraperitoneal kidney transplant was firmly adhered to the uterus,
right pelvic sidewall and adnexa. Right pelvic lymph node debulking was
performed but not paraaortic lymph node dissection because of increased
morbidity of this case.
The final pathology showed ovarian serous
adenocarcinoma with clear cell features, without involvement of
endometrium, lymph nodes and negative peritoneal washings. We believe
that the intrauterine pathological finding during the first surgery was
"drop lesion" from the ovary to the uterine cavity. Thus, the final
stage assigned was
IC1, secondary to ovarian
cyst rupture at the initial
surgery. She received six cycles of intravenous Carboplatin and Taxol.
There is no evidence of recurrence in nine-month follow up.
CONCLUSION:
The
incidence of malignancies
is increasing in cases of renal transplant
secondary to the age of patients and the
immunosuppressive therapy
Berardino and Mascaretti (2008 Jan 1), Ripley et al. (1995 Oct) [2,3].
Laparoscopic surgical treatment for gynecologic malignancies can be
challenging due to location of transplanted kidney in the pelvis
Teneriello et al. (1993 Sep 30) [4]. We present a rare case of
laparoscopic ovarian cancer staging with intraperitoneal renal
transplant, which can be safely performed in hands of a skilled
laparoscopic surgeon.
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