Lymphorrhea is a relatively rare postoperative complication after retroperitoneal lymph node dissection. Normally, a lymphatic leakage closes spontaneously before it becomes symptomatic. However, some severe, prolonged cases require immediate treatment. Here, we report a case requiring a multidisciplinary intervention for a diagnosis and ascites effusion control after radical hysterectomy. A 41-year-old nulliparous woman with a chief complaint of abnormal vaginal bleeding was referred to our institution. We performed radical hysterectomy, including pelvic lymph node dissection after neoadjuvant chemotherapy based on a cervical cancer stage IIB diagnosis. On postoperative day 52, massive ascitic fluid without chyle developed. Conservative treatment failed to control the ascites, and approximately 36 L of ascites was drained over three months. Subsequent lipoprotein analysis of the ascites detected chylomicron, resulting in a lymph ascites diagnosis owing to postoperative lymph leakage. We performed lymph embolization by lymphangiography and ligation of lymphatic leakage by laparotomy. Finally, we performed lymphaticovenular anastomosis, which relieved the lower limb lymphedema without causing ascites relapse. If ascitic fluid is observed after lymph node dissection, lymphatic ascites should be considered regardless of the presence of chyle.

Adenocarcinoma of the vulva is rare. Lesions of the posterior vaginal vestibule are often assumed to be primary lesions of the Bartholin's glands. We report a case where vulvar adenocarcinoma in a Crohn's disease patient was diagnosed as cancer arising from an anal fistula following resection. A 48-year-old woman received treatment for Crohn's disease. Six months prior, she had a tumor of the left vulvar area, close to the vaginal vestibule. Adenocarcinoma was confirmed based on biopsy results. Upper and lower gastrointestinal endoscopy performed was negative. Accordingly, Bartholin's adenocarcinoma was suspected. On the first visit, a 4 cm mass was found in the left Bartholin's gland area. CT revealed mild bilateral inguinal lymph node hypertrophy. We performed simple vulvectomy and bilateral inguinal lymph node sampling for biopsy. The pathological diagnosis was moderately different from adenocarcinoma. A continuity was observed between the colonic mucosal epithelium and the adenocarcinoma. Accordingly, anal fistula cancer was confirmed. The excision margin was positive on the deep exfoliated surface of the left vaginal wall. Subsequently, robot-assisted laparoscopic abdominal perineal resection, vaginal perineal resection, colon stoma construction, and inguinal lymph node dissection were performed. Capecitabine plus oxaliplatin (CAPOX) chemotherapy is currently being administered to the patient. Vulvar adenocarcinoma with Crohn's disease should be scrutinized with suspicion of anal fistula cancer.

For a diagnosis of malignant peritoneal mesothelioma, the tumor must pathologically be shown to have mesothelial cell origin and features of malignancy. Immunohistological methods to demonstrate the former have been largely established; however, methods to determine the latter are as yet unclear. Here we report a case of malignant peritoneal mesothelioma diagnosed by histopathological examination of an excised recurrent lesion. The patient was 52 years old (gravida 0, para 0). She underwent laparotomy for a uterine leiomyoma, and a fragile necrotic mass was found in the Douglas' pouch. Immunostaining of the mass showed no BAP1 loss or MTAP loss, and the mass was diagnosed as mesothelial hyperplasia. The patient returned to our clinic 24 months postoperatively with lumbar back pain. A computed tomography scan revealed findings suggestive of disseminated neoplastic lesions, and an open tissue biopsy was performed. Immunostaining of the excised specimen showed BAP1 loss and MTAP loss, and a diagnosis of malignant mesothelioma-epithelial type was made. Immunostaining based on specific genetic mutations was performed on both specimens, but the results were contradictory. However, considering the similarities in the clinical course and histology of the two specimens, the initial specimen was also thought to be a malignant mesothelioma.