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Sunday, June 12, 2016

Ovarian cancer laparoscopic hysterectomy and staging in a patient with history of intraperitoneal renal transplant



Ovarian cancer laparoscopic staging of patient with intraperitoneal renal transplant.


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.


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.


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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