Laparoscopic-Assisted Hysteroscopic Surgery for Endometrial
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A 70-year-old woman came to our hospital and presented with postmenopausal vaginal bleeding. The pathological diagnosis of cervical biopsy revealed adenocarcinoma. Computed tomography (CT) and magnetic resonance imaging (MRI) showed locally advanced cervical cancer that extended into the endometrium and pelvic sidewall, as well as bilateral hydronephrosis, but no other metastatic tumor was observed. The patient was diagnosed with cervical cancer stage IIIB. She underwent concurrent chemoradiotherapy. External beam radiation therapy at 50.4?Gy with conformal blocking against the whole pelvis, boost radiation therapy, and brachytherapy was performed. Platinum-based concurrent chemotherapy (cisplatin 40?mg/m2 weekly) was also performed. After radiation therapy, a complete response was considered.

After 12 months of concurrent chemoradiotherapy, ultrasonography showed tumors in the uterine cavity and pyometra. The serum CA-125 value was 41?U/ml. T2-weighted MRI showed markedly high-intensity liquid and tumors in the uterine cavity. Contrast-enhanced MRI showed two tumors in the uterine cavity with an enhancement effect. Positron emission tomography-CT showed no clear uptake in the whole body. The tumors’ major axis growth was 8?mm to 15?mm in 3 months. Since radiation therapy-induced cervical stenosis was conducted, the endometrial examination could not be performed without anesthesia.

A laparoscopic-assisted transcervical hysteroscopic resection was performed for the diagnosis and treatment. At first, the abdominal cavity was observed laparoscopically. The mobility of the uterus was very poor due to its strong adhesion by radiation therapy. Bilateral fallopian tubes were sealed with a bipolar coagulator. Secondly, after watchful cervical dilation, the uterine cavity was observed hysteroscopically. An atrophic endometrium and two tumors were confirmed. The tumors were excised with an electric scalpel and discharged outside the uterus. The tumor stump and other parts of the endometrium were biopsied. The hysteroscopic surgery was laparoscopically monitored to prevent complications. Pathological diagnosis revealed endometrial polyps, which were stump-negative. At the 2-year follow-up postsurgery, there was no tumor recurrence.