分葉状子宮頸管腺過形成に対する子宮頸部円錐切除後の腹腔鏡下子宮全摘術で、傍子宮結合織の追加切除を施行した一例

抄録

　Lobular endocervical glandular hyperplasia (LEGH) is a rare benign hyperplastic lesion of the cervix that frequently arises from an upper lesion. Differential diagnosis of LEGH and minimal deviation adenocarcinoma (MDA) using imaging, cervical cytology, and biopsy is challenging. Cervical conization may help in the differential diagnosis of LEGH and MDA; however, conization involving an upper cervical lesion thins the remaining cervix, leading to uterine perforation during subsequent laparoscopic hysterectomy. Here, we report a case of LEGH that required additional resection of the remaining cervix and parametrial connective tissue during laparoscopic hysterectomy because of cervical perforation perioperatively. A 42-year-old uniparous woman with a multi-cystic cervical lesion was referred to our facility for suspected LEGH. Diagnostic cervical conization revealed LEGH with positive surgical margin; therefore, we performed laparoscopic hysterectomy. As we cut parametrium using the vessel-sealing system, we cut the endocervical tissue and accidentally perforated the cervix. Thus, we performed additional resection of the bilateral parametrial connective tissue that included the remaining cervix, following the procedure of the vesico-uterine ligament as performed in radical hysterectomy. The pathological diagnosis of the uterus was LEGH and the surgical margins were negative. Resected tissues showed no evidence of LEGH. In laparoscopic hysterectomy performed after conization, surgical techniques should be adjusted considering thinning of the remaining cervical tissue. The surgical technique used in radial hysterectomy helped to remove the residual cervix and parametrial tissue.