全腹腔鏡下子宮全摘出時の予防的卵管切除により微小な左卵管癌と診断された一例

抄録

Introduction: Prophylactic salpingectomy is increasingly being performed concurrently with hysterectomy to reduce the risk of future ovarian and fallopian tubal cancer. We report a case of left tubal cancer incidentally diagnosed during prophylactic salpingectomy at the time of total laparoscopic hysterectomy.

Case: A 50-year-old nullipara with menorrhagia was diagnosed with submucosal uterine myoma during a medical examination and presented to our hospital for further treatment. Uterine cytology showed negative results. Magnetic resonance imaging revealed a submucosal uterine myoma (3 cm), and the adnexa showed no abnormalities bilaterally.

  Total laparoscopic hysterectomy and bilateral salpingectomy were performed 7 months after her initial visit. Intraoperatively, no mass was identified in the bilateral adnexa. Postoperative histopathological examination revealed an endometrioid carcinoma (2 mm) in the left tubal fimbriae. Postoperative contrast-enhanced computed tomography revealed no lymphadenopathy or metastasis. Abdominal bilateral oophorectomy and partial omentectomy were performed 2.5 months after the initial operation.

  Lymphadenectomy was not performed owing to the diminutive size of the lesion without any clinical suspicion of lymphadenopathy or dissemination. Washing cytology specimens revealed negative results, and postoperative histopathological findings showed no residual tumor. The left tubal cancer was diagnosed as a stage IA lesion (the International Federation of Obstetrics and Gynecology 2014 classification); therefore, no postoperative therapy was required. She was recurrence-free 12 months after the second surgery.

Conclusion: Patients scheduled for hysterectomy to treat benign gynecological disease should be informed that concurrent bilateral salpingectomy may reduce the risk of future ovarian cancer.