2022 Volume 38 Issue 1 Pages 158-163
Lymphangioleiomyomatosis (LAM) is a rare disease in which multiple cysts are formed mainly in the lungs and symptoms such as dyspnea, bloody sputum, and chyle effusion appear. We experienced a case of endometrial cancer with a para-aortic mass that was initially suspected to be due to metastasis. However, after resection by retroperitoneoscopic surgery, the mass was diagnosed as LAM and fertility-sparing therapy was started.
[Case] The patient was a 28-year-old woman (0G0P) who consulted a nearby doctor for abnormal genital bleeding, and was diagnosed with endometrioid carcinoma G1. CT showed a mass in the para-aortic region and a 6-cm left ovarian mass. MRI showed no obvious myometrial invasion, and the left ovarian cystic mass was suspected to be a mature cyst teratoma. The tumor in the para-aortic region was hyperintense on T2-weighted images and had a high ADC on diffusion-weighted images. These findings are atypical for lymph node metastasis. Since the patient was young, she requested fertility-preserving therapy, but the possibility of lymph node metastasis of endometrial cancer could not be ruled out. Therefore, we decided to remove the para-aortic mass using a retroperitoneoscopic approach. The patient was discharged on postoperative day 4 without complications. Histopathological examination indicated that the para-aortic mass was due to LAM and endometrial cancer was diagnosed as stage IA, after which MPA treatment was started.
[Discussion] Diagnosis of para-aortic tumors is difficult by imaging, and pathological examination is required. Retroperitoneoscopic resection of a para-aortic tumor is beneficial because it allows diagnosis with minimal invasiveness.
