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Abstract
Introduction/Background It was aimed to present a case of endometrioid adenocancer (EC) which invaded the left parametrium including the distal ureter.
Methodology A 54-years-old multiparous woman admitted the gynecologic oncology clinic of a tertiary referral hospital with the complaint of abnormal uterine bleeding. Pathologic examination of the endometrial curattege material was reported as grade 3 EC. Abdominopelvic computed tomography revealed left renal pyeliectasia, paraaortic lymphadenopathy, a solid mass of 55-mm in diameter in the left parametrium and a polypoid mass of 43-mm in diameter filling the uterine cavity. During the staging laparatomy, total abdominal hysterectomy, bilateral salphingooopherectomy, omentectomy and pelvic-paraaortic lymphadenectomy was performed.
Results During hysterectomy procedure, it was seen that the bottom of left parametrium was filled by a solid mass, extending from the isthmic-cervical portion of the uterus towards the parametrium, which was fixed to the distal ureter resulting in the dilation of the proximal ureter (figure 1). Ureteroneocystostomy was performed via the bladder mobilisation and tunneling of the ureter in the bladder wall using the Psoas Hitch tecnique. A double J stent was placed and left for 3 weeks. During the pelvic-paraaortic lymphadenectomy, there was a bulky lymph node fixed to the aorta and inferior vena cava at a level just below the left renal artery which was dissected without any complication (figure 2). A drain was left in the pelvis for 3 days. Postoperative follow up of the patient was uneventful and she was discharged on the 5. Day. A foley catheter was left in the bladder for 14 days. There was no urinary complication developed in the postoperative period. Based on the final pathologic report, the tumor was stage 3
Conclusion In this case report, parametrial and distal ureteral invasion due to endometriod adenocancer was presented.
Disclosure Nothing to disclose.
An intraoperative image showing the bulky lymph node (star) adherent to the aorta (arrow)
An intraoperative image of dilated left ureter (arrow) due to distal ureteric obstruction