Laparoscopic Complete Excision of a Recurrent Uterine Primitive Neuroectodermal Tumor Appearing as a Huge Metastatic Lymph Node

Abstract

Introduction: Primitive neuroectodermal tumor (PNET) is a rare malignant neoplasm that can occur in the female genital tract.1 To date, only 64 cases of primary uterine PNET have been reported, but no conclusions have been reached concerning therapeutic management.2 Complete debulking surgery is generally recommended as the first step in the treatment of primary uterine PNET,3 and no recommendations exist for treatment of recurrent PNET. This video illustrates a case of recurrent uterine PNET for which laparoscopic complete resection was performed. Materials and Methods: A 51-year-old woman underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy for a presumed stage IA endometrial carcinoma, which was determined upon postoperative histochemical examination to be a PNET of the uterine corpus. Adjuvant chemotherapy (three courses of etoposide and cisplatin) was performed. Two months later, multiple lymph node metastases were detected, and severe right leg edema and pain were identified secondary to an 8-cm metastatic lymph node at the right pelvic sidewall. A laparoscopic lymph node excision was recommended to improve the patient's quality of life (QOL). The video shows the operative procedure used to perform the lymphadenectomy with removal of the huge metastatic lymph node that was compressing the external iliac vein. Results: Complete lymph node excision was achieved. The operation took 517 min with an estimated blood loss of 830 mL. Blood transfusion was not required. The right leg edema and pain resolved completely, and no complication ensued. Two months later, there has been no adjuvant chemotherapy or radiotherapy, and there has been no sign of recurrence. Conclusion: Laparoscopic complete excision of recurrent uterine PNET is technically feasible and can improve the patient's QOL. No competing financial interests exist. Runtime of video: 6 mins 3 secs