Abstract
Objective: Cervical cystic lesions are often observed in gynecological clinical practice. Many are caused by benign diseases such as lobular endocervical glandular hyperplasia (LEGH), and it is important to differentiate these lesions from those due to malignant diseases such as minimal deviation adenocarcinoma (MDA). In cases in which fertility preservation is not a concern, the final pathology is often confirmed by hysterectomy. To investigate the feasibility and safety of laparoscopic surgery for cervical cystic lesions, we retrospectively examined cases in which total laparoscopic hysterectomy (TLH) was performed for diagnosis and treatment. Methods: The subjects were 28 women who underwent TLH from April 2012 to March 2017 at Keio University Hospital. The pre- and post-operative courses of these patients were examined. Results: The average age was 49.4 (range 39 - 65) years and the mean body mass index was 21.7 (16.8 - 30.5) kg/m2. The average operation time was 159 (101 - 314) min and the average bleeding volume was 106.8 (0 - 600) g. There were no severe perioperative complications. The average hospital stay was 8.4 (7 - 14) days. In postoperative pathological diagnosis, 13 cases had benign diseases such as Nabot cysts, there were 14 cases of LEGH, and one patient was diagnosed with MDA. In the MDA case, additional bilateral salpingo-oophorectomy and pelvic lymph node dissection were performed at a later date. No metastasis was observed in these excised specimens. Conclusions: Our results suggest that TLH for cervical cystic lesions can be performed safely. However, it is important to consider the TLH indication before surgery based on the possibility of malignant disease.
Highlights
Cervical cystic lesions are common in gynecological clinical practice
Many are caused by benign diseases such as lobular endocervical glandular hyperplasia (LEGH), and it is important to differentiate these lesions from those due to malignant diseases such as minimal deviation adenocarcinoma (MDA)
As a cervical cystic lesion, benign diseases including lobular endocervical glandular hyperplasia (LEGH) are difficult to distinguish from malignant diseases such as minimal deviation adenocarcinoma (MDA) [1]
Summary
Cervical cystic lesions are common in gynecological clinical practice. As a cervical cystic lesion, benign diseases including lobular endocervical glandular hyperplasia (LEGH) are difficult to distinguish from malignant diseases such as minimal deviation adenocarcinoma (MDA) [1]. MDA is an extremely well-differentiated mucinous adenocarcinoma with only minimal histological deviation from normal cervical glands, and its prognosis is poor due to resistance to surgical treatment and chemotherapy [2] [3] [4] Due to their characteristics, MDA lesions are often misdiagnosed as benign lesions of the uterine cervix by cytology or in small-sized superficial biopsies [5]. LEGH was first reported by Nucci et al as a benign lesion characterized by lobular proliferation of glands lined by endocervical mucin-producing epithelial cells [6] Both MDA and LEGH present as a multicystic mass in the uterine cervix in methods such as magnetic resonance imaging (MRI), which makes differential diagnosis of cervical cystic lesions difficult [7] [8]. Proper preoperative diagnosis may not be obtained even after performing cervical conization
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