2020 Volume 36 Issue 2 Pages 253-257
[Case] A 50-year-old gravida 2, para 1 presented with multiple fibroids and a right ovarian tumor. Magnetic resonance imaging (MRI) revealed multiple uterine fibroids and a right ovarian tumor (4 cm) without any signs suggestive of malignancy. We performed total laparoscopic hysterectomy (TLH) after completion of 6 courses of gonadotropin-releasing hormone (GnRH) agonist therapy. Intraoperatively, we observed endometriosis around Douglas' pouch and the left adnexa; therefore, we performed simultaneous left salpingo-oophorectomy. The right ovary appeared normal in size. Postoperative histopathological examination revealed uterine fibroids and adenomyosis, and the left ovary showed no neoplastic lesions. Transvaginal ultrasonography performed at her 3-month postoperative follow-up revealed an enlarged right pelvic tumor (5 cm). MRI findings were suspicious for cancer, such as gastrointestinal stromal tumor. Therefore, a gastrointestinal surgeon performed concurrent laparotomy. The edematous pelvic tumor measured 9 cm in size with peripheral adhesions. We performed resection of the pelvic tumor and pelvic lymph node sampling (operation time 129 min, estimated blood loss 590 mL). Ascites fluid cytology evaluation showed negative results. Histopathological examination confirmed the diagnosis of ovarian endometrioid carcinoma G1. The patient received 6 courses of postoperative dose-dense paclitaxel-carboplatin therapy uneventfully, and no recurrence has occurred to date.
[Summary] Ovarian endometrioid carcinoma rarely shows rapid progression. Preoperative GnRH analogue administration might mask ovarian endometrioid cancer.
