title: Vulvar metastasis of an early-stage well-differentiated endometrial cancer after minimally invasive surgery.
abstract: Endometrial cancer is the most common gynecologic malignancy, often manifesting as early-stage well-differentiated endometrioid adenocarcinoma associated with a high likelihood of long-term recurrence-free survival. Minimally invasive surgery for surgical staging of endometrial lesions is now routinely practiced, with laparoscopy the preferred surgical approach at many cancer centers. Recurrence or metastasis of early-stage well-differentiated endometrial endometrioid adenocarcinoma is uncommon, and may occur due to iatrogenic microscopic seeding of malignant cells during surgery, as suggested by previous reports of cancer metastasis to port sites after minimally invasive surgery, laparotomy incisions after open surgery, or intraperitoneal spread after hysteroscopy or uterine manipulation. Herein we report the only described case of isolated vulvar metastasis of an early-stage FIGO stage IB well-differentiated (histologic grade 1) endometrial endometrioid adenocarcinoma after minimally invasive surgery for surgical staging. The patient had recurrent endometrioid adenocarcinoma metastasis at the vulva 8 months after robotic-assisted total laparoscopic hysterectomy and surgical staging with specimen removal through the vagina. In selected cases, we suggest that use of a specimen bag during removal of the uterus through the vagina may limit seeding of malignant cells during minimally invasive surgery to treat cancer.
authors: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Western Connecticut Health Network, Danbury Hospital, Danbury, Connecticut.
authors: Amer
authors: A
authors: Abdullah
authors: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Western Connecticut Health Network, Danbury Hospital, Danbury, Connecticut.
authors: Brandon-Luke L
authors: BL
authors: Seagle
authors: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Western Connecticut Health Network, Danbury Hospital, Danbury, Connecticut.
authors: Erleine
authors: E
authors: Bautista
authors: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Western Connecticut Health Network, Danbury Hospital, Danbury, Connecticut.
authors: Barinder S
authors: BS
authors: Hansra
authors: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Western Connecticut Health Network, Danbury Hospital, Danbury, Connecticut.
authors: Robert
authors: R
authors: Samuelson
authors: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Western Connecticut Health Network, Danbury Hospital, Danbury, Connecticut. Electronic address: Shohreh.Shahabi@wchn.org.
authors: Shohreh
authors: S
authors: Shahabi
mesh_terms: D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000556:secondary*; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D010535:Laparoscopy; D019060:Minimally Invasive Surgical Procedures; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D014846:Vulvar Neoplasms / Q000556:secondary*
keywords: Endometrial cancer; Metastasis; Minimally invasive surgery; Surgical staging; Vulva