Page 39 - World Journal of Laparoscopic Surgery

CASE REPORT
Laparoscopic Management of Suspected Vault Recurrence

Following Staging Surgery of Endometrial Cancer

1
Ajay Agrawal , Kuan-Gen Huang 2

AbstrAct
Background: Postoperative issues with the vaginal vault after hysterectomy for benign or malignant conditions are not common. However,
these include vault hematoma, granuloma, keloid, incisional hernia, vascular formation, and recurrence of pelvic malignancy at the vault.
Case description: A 47-year-old woman with a history of breast cancer surgery under tamoxifen developed endometrial carcinoma stage 1
for which she underwent staging laparoscopy 1 year ago. She presented with a vaginal cuff tumor of 3 cm detected vaginally 3 months later
which was suspicious of recurrence. Laparoscopic management was done and circumferential excision of vaginal cuff margin and repair was
done. The final pathology report revealed infection and granulation tissue in the excised margin.
Conclusion: Management of vaginal cuff complications following hysterectomy can be feasible by minimally invasive surgery regardless of
indication of primary surgery.
Keywords: Endometrial cancer, Laparoscopic management, Vault recurrence.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1420

bAckground 1 Department of Obstetrics and Gynecology, BP Koirala Institute of

Postoperative issues with the vaginal vault after hysterectomy are Health Sciences, Dharan, Kosi (Anchal), Nepal
not very common. These complications include vault hematoma, 2 Department of Obstetrics and Gynecology, Chang Gung Memorial
granuloma, keloid, incisional hernia, vascular formation, fistula, Hospital, Linkou, Taoyuan, Taiwan, Republic of China
prolapse of the oviduct, and recurrence of pelvic malignancy at Corresponding Author: Kuan-Gen Huang, Department of Obstetrics
1
the vault. Out of these, vaginal vault granulation is a commonly and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan,
observed benign sequela of hysterectomy. Regarding the recurrence Taiwan, Republic of China, Phone: +886975365887, e-mail: kghuang@
of pelvic malignancy, approximately 6–13% of all patients with ms57.hinet.net
endometrial cancer will develop the recurrent disease and most How to cite this article: Agrawal A, Huang KG. Laparoscopic
2
of these are located at the vaginal vault. Indications for surgical Management of Suspected Vault Recurrence Following Staging
treatment depend on resectability, site and size of the tumor, and Surgery of Endometrial Cancer. World J Lap Surg 2020;13(3):138–139.
performance status of the patient. Both these conditions have a Source of support: Nil

common initial presentation with vaginal bleeding, discharge, and Conflict of interest: None
fleshy growth in the vaginal cuff. Here, we present a case of a woman
who was suspected to have vaginal cuff recurrence following
staging laparoscopy done for endometrial cancer.

cAse description

A 47-year-old woman with right breast infiltrative ductal carcinoma
had surgical treatment in 2015 at Chang Gung Memorial Hospital,
Linkou, Taiwan and was under regular follow-up. She was under
tamoxifen with yearly surveillance of her endometrial thickness.
Three years later, she had abnormal endometrial thickness which
on hysteroscopic biopsy was proven to be endometrial cancer. So,
she underwent staging laparoscopy with total hysterectomy and
adnexal removal in January 2019. Histopathology revealed The
International Federation of Gynecology and Obstetrics (FIGO) stage
1a grade I endometrial cancer.
Three months later, she presented with a vaginal discharge of
2 weeks duration. On vaginal exam using a colposcopy, there was a
cuff lesion with the appearance of ulcer or granulation tissue, over
a nodule of 3 cm, which was angry red, velvety, and bled on touch
(Fig. 1). Vaginal biopsy showed acute on chronic inflammation Fig. 1: Colposcopy shows red, velvety vaginal cuff with some swelling
and magnetic resonance imaging (MRI) of the abdomen revealed which bled on touch

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