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Laparoscopic Resection of a Retroperitoneal Mass: a Case Report
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 427
Virtual Posters – Session 2 (12:45 PM – 1:45 PM) 1:15 PM – STATION A
Laparoscopic Resection of a Retroperitoneal Mass: a Case Report Beale S, Grant A, Nimaroff M. Obstetrics and Gynecology, North Shore University Hospital Northwell Health, Manhasset, New York Study Objective: Review case of retroperitoneal mass initially diagnosed as adnexal mass in a postmenopausal female. Design: Case Report. Setting: Academic Affiliated Hospital. Patients: This is a case report of a 70 year old woman with abnormal uterine bleeding. Upon evaluation, endometrium was normal, however, imaging revealed a complex right adnexal cyst. Her medical history included type 2 diabetes, hypertension and an anterior angiomyolipoma in the right kidney. Initial ultrasonography showed a posterior 1.90 × 1.3 × 1.4 cm fibroid and an unchanged anterior AML in the right kidney. Ultrasonography at 7 months follow-up showed an enlarged right ovary containing a 2.7 × 1.7 × 1.5 cm hypoechoic nodule not identified on previous sonogram. Further evalua-
S145
tion with computerized tomography (CT) demonstrated a 5.8 × 3.9 cm right complex adnexal cyst. Serum cancer antigen 125 level was normal. Intervention: Patient underwent a Laparoscopic Bilateral Salpingooophorectomy. Intraoperative findings revealed bilateral normal adnexa with a 5 cm retroperitoneal mass adherent to right psoas muscle and immediately adjacent to right ovary. General surgery was consulted and the mass was resected from underlying psoas muscle. Measurements and Main Results: Gross pathological examination revealed normal adnexa bilaterally. Examination of the retroperitoneal mass revealed thickened wall with inflammatory features and necrosis. Histologically, a fibromembranous tissue with mixed chronic inflammatory cells, abundant fibrinoid material, and calcifications without tissue lining negative for carcinoma. Postoperatively, the patient experienced peripheral neuropathy and was treated with physical therapy and gabapentin with symptomatic improvement. Conclusion: Per ACOG recommendations, a pelvic mass and elevated CA 125 in postmenopausal women is suspicious for malignancy. Patients should be referred to gyn oncology or treated with gyn oncology available. Minimally invasive procedures are preferred route of surgery. Primary masses of pelvic retroperitoneum are rare, but often diagnosed as gynecologic in origin. The accurate preoperative diagnosis of intraperitoneal mass (most being gynecologic in nature) versus a retroperitoneal mass guides therapeutic approach.
428
Virtual Posters – Session 2 (12:45 PM – 1:45 PM) 1:15 PM – STATION B
Fig. 1. Computed Tomography (CT) demonstrating “adnexal mass”.
Laparoscopic Resection of Interstitial Ectopic Pregnancy Remnants Kuriya A, Scattolon S, Leyland NA. Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada This case highlights a rare, yet important complication of medical management of ectopic pregnancies. The case presented is of a 38 year old G3P2 @ 8 + 2 who was initially diagnosed with an interstitial left ectopic pregnancy. She was treated with multidose methotrexate and leucovorin rescue and followed until her bhcg resolved to zero. She presented two months following her treatment with pelvic pain and left lower quadrant pain. An ultrasound revealed a 1.9 x 2.3 x 2.6 cm heterogenous mass in the left cornual region consisting of ectopic remnants. The patient was ultimately consented for a left cornual wedge resection, resection of endometriosis and opportunistic bilateral salpingectomy as she had no desire for future fertility. She recovered well post op and her pelvic pain improve. The final pathology results confirmed hyalinized chorionic villi compatible with residual remote ectopic pregnancy.
429
Virtual Posters – Session 2 (12:45 PM – 1:45 PM) 1:15 PM – STATION C
Laparoscopic Resection of the Rudimentary Uterine Horn: a Report of Three Cases Taniguchi TS, Tsuchiya T, Shibutani T, Fukuda Y, Maemura T, Katagiri Y, Morita M. Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Ota-ku, Tokyo, Japan
Fig. 2. Intraoperative pictures of retorperitoneal mass.
Study Objective: Unicornuate uterus is a rare type of uterine malformation which affects 0.1 % of women. It is often diagnosed incidentally along with hematometra, endometriosis, infertility, and ectopic pregnancy. The objective of this study was to report our experience of laparoscopic resection of rudimentary horn in three cases with unicornuate uterus. Design: Descriptive study.
Virtual Posters – Session 2 (12:45 PM – 1:45 PM) 1:15 PM – STATION A
Laparoscopic Resection of a Retroperitoneal Mass: a Case Report Beale S, Grant A, Nimaroff M. Obstetrics and Gynecology, North Shore University Hospital Northwell Health, Manhasset, New York Study Objective: Review case of retroperitoneal mass initially diagnosed as adnexal mass in a postmenopausal female. Design: Case Report. Setting: Academic Affiliated Hospital. Patients: This is a case report of a 70 year old woman with abnormal uterine bleeding. Upon evaluation, endometrium was normal, however, imaging revealed a complex right adnexal cyst. Her medical history included type 2 diabetes, hypertension and an anterior angiomyolipoma in the right kidney. Initial ultrasonography showed a posterior 1.90 × 1.3 × 1.4 cm fibroid and an unchanged anterior AML in the right kidney. Ultrasonography at 7 months follow-up showed an enlarged right ovary containing a 2.7 × 1.7 × 1.5 cm hypoechoic nodule not identified on previous sonogram. Further evalua-
S145
tion with computerized tomography (CT) demonstrated a 5.8 × 3.9 cm right complex adnexal cyst. Serum cancer antigen 125 level was normal. Intervention: Patient underwent a Laparoscopic Bilateral Salpingooophorectomy. Intraoperative findings revealed bilateral normal adnexa with a 5 cm retroperitoneal mass adherent to right psoas muscle and immediately adjacent to right ovary. General surgery was consulted and the mass was resected from underlying psoas muscle. Measurements and Main Results: Gross pathological examination revealed normal adnexa bilaterally. Examination of the retroperitoneal mass revealed thickened wall with inflammatory features and necrosis. Histologically, a fibromembranous tissue with mixed chronic inflammatory cells, abundant fibrinoid material, and calcifications without tissue lining negative for carcinoma. Postoperatively, the patient experienced peripheral neuropathy and was treated with physical therapy and gabapentin with symptomatic improvement. Conclusion: Per ACOG recommendations, a pelvic mass and elevated CA 125 in postmenopausal women is suspicious for malignancy. Patients should be referred to gyn oncology or treated with gyn oncology available. Minimally invasive procedures are preferred route of surgery. Primary masses of pelvic retroperitoneum are rare, but often diagnosed as gynecologic in origin. The accurate preoperative diagnosis of intraperitoneal mass (most being gynecologic in nature) versus a retroperitoneal mass guides therapeutic approach.
428
Virtual Posters – Session 2 (12:45 PM – 1:45 PM) 1:15 PM – STATION B
Fig. 1. Computed Tomography (CT) demonstrating “adnexal mass”.
Laparoscopic Resection of Interstitial Ectopic Pregnancy Remnants Kuriya A, Scattolon S, Leyland NA. Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada This case highlights a rare, yet important complication of medical management of ectopic pregnancies. The case presented is of a 38 year old G3P2 @ 8 + 2 who was initially diagnosed with an interstitial left ectopic pregnancy. She was treated with multidose methotrexate and leucovorin rescue and followed until her bhcg resolved to zero. She presented two months following her treatment with pelvic pain and left lower quadrant pain. An ultrasound revealed a 1.9 x 2.3 x 2.6 cm heterogenous mass in the left cornual region consisting of ectopic remnants. The patient was ultimately consented for a left cornual wedge resection, resection of endometriosis and opportunistic bilateral salpingectomy as she had no desire for future fertility. She recovered well post op and her pelvic pain improve. The final pathology results confirmed hyalinized chorionic villi compatible with residual remote ectopic pregnancy.
429
Virtual Posters – Session 2 (12:45 PM – 1:45 PM) 1:15 PM – STATION C
Laparoscopic Resection of the Rudimentary Uterine Horn: a Report of Three Cases Taniguchi TS, Tsuchiya T, Shibutani T, Fukuda Y, Maemura T, Katagiri Y, Morita M. Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Ota-ku, Tokyo, Japan
Fig. 2. Intraoperative pictures of retorperitoneal mass.
Study Objective: Unicornuate uterus is a rare type of uterine malformation which affects 0.1 % of women. It is often diagnosed incidentally along with hematometra, endometriosis, infertility, and ectopic pregnancy. The objective of this study was to report our experience of laparoscopic resection of rudimentary horn in three cases with unicornuate uterus. Design: Descriptive study.