Transanal total mesorectal excision for primary rectovaginal carcinosarcoma: A case report and literature review
Transanal total mesorectal excision for primary rectovaginal carcinosarcoma: A case report and literature review
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DOI：
10.1111/jog.15487
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发表时间：
2022-11-11
影响因子：
1.6
通讯作者：
Murakami，Takashi
中科院分区：
文献类型：
--
作者：
Onishi，Takuto;Amano，Tsukuru;Murakami，Takashi
我们报告一例直肠阴道隔癌肉瘤，在铂类新辅助化疗后，通过经肛门全直肠系膜切除术成功治疗。一名48岁女性在访视前出现3周排便疼痛。盆腔成像显示直肠阴道隔下部有一个8 cm大小的病变。行阴道活检和免疫组化分析。经过三个疗程的卡铂-紫杉醇-贝伐单抗治疗，肿块减少了一半。随后，腹腔镜切除术与经肛门全直肠系膜切除术，并广泛子宫切除术。肛门得以保留，排尿困难在一个月内得到改善。最后的组织病理学诊断为直肠阴道隔癌肉瘤，起源不明，可能是直肠癌或中肾癌。手术后12个月，证实了孤立性肝转移;然而，没有证据表明局部复发。铂类新辅助化疗后的全直肠系膜切除术可能是直肠阴道隔妇科恶性肿瘤的理想治疗方法，尤其是盆腔深部的大肿瘤。
We report a case of rectovaginal septum carcinosarcoma successfully treated with surgical excision via transanal total mesorectal excision following platinum‐based neoadjuvant chemotherapy. A 48‐year‐old woman presented with a 3‐week defecation pain preceding the visit. Pelvic imaging showed an 8‐cm sized lesion in the lower rectovaginal septum. Transvaginal biopsy and immunohistochemical analysis were performed. After three courses of carboplatin‐paclitaxel‐bevacizumab therapy, the mass reduced by half. Subsequently, laparoscopic excision with transanal total mesorectal excision, and radical hysterectomy were performed. The anus was preserved, and dysuria improved within a month. The final histopathological diagnosis was carcinosarcoma of the rectovaginal septum from an uncertain origin, presumably endometriotic or mesonephric. Twelve months following surgery, solitary liver metastasis was confirmed; however, there was no evidence of local recurrence. Total mesorectal excision following platinum‐based neoadjuvant chemotherapy may be an ideal treatment for gynecological malignancies in the rectovaginal septum, especially for large tumors localized deep into the pelvis.