内容紹介
Transvaginal Ultrasound-Guided Core Needle Biopsy for Residual Potentially Malignant Ovarian Tumors in Cases with Severe Peritoneal Adhesion and Frozen Pelvis Requiring Polysurgery
Summary
A multiparous woman in her 40s had advanced peritoneal adhesions and frozen pelvis from 3 previous surgeries. Endometrial ovarian cysts also remained. After the last surgery, imaging showed cysts with a septum and enhanced moieties in the Douglas pouch. Highly invasive surgery was anticipated, and the patient underwent a transvaginal ultrasound-guided core needle biopsy(TVCNB, 16-gauge needle)with full awareness of the risks involved. The histopathological diagnosis was adenocarcinoma. We inserted a ureteral stent and performed an S-shaped colon resection and standard ovarian cancer surgery after preoperative chemotherapy. TVCNB in this case was less invasive and easier to perform than other exploratory procedures, and has a low risk of iatrogenic intraperitoneal dissemination even if the tumor is malignant. Chemotherapy can be administered before surgery if malignancy is detected. In summary, TVCNB is a useful alternative method for conducting exploratory operations.
要旨
症例は40代,2経妊2経産2回の帝王切開歴あり,子宮筋腫卵巣嚢腫の手術で強度癒着,凍結骨盤が確認されていた。その後,残存した卵巣嚢腫の悪性が疑われ卵巣癌の標準治療として試験開腹術を検討したが,経腟超音波ガイド下針生検を先行すると病理組織診で悪性が確定した。術前化学療法を行うことで,術後の腸管尿路系合併症を最小限に抑えた。このような症例に対して,経腟的卵巣嚢腫針生検は試験開腹術の代替え検査法として有用である。
目次
Summary
A multiparous woman in her 40s had advanced peritoneal adhesions and frozen pelvis from 3 previous surgeries. Endometrial ovarian cysts also remained. After the last surgery, imaging showed cysts with a septum and enhanced moieties in the Douglas pouch. Highly invasive surgery was anticipated, and the patient underwent a transvaginal ultrasound-guided core needle biopsy(TVCNB, 16-gauge needle)with full awareness of the risks involved. The histopathological diagnosis was adenocarcinoma. We inserted a ureteral stent and performed an S-shaped colon resection and standard ovarian cancer surgery after preoperative chemotherapy. TVCNB in this case was less invasive and easier to perform than other exploratory procedures, and has a low risk of iatrogenic intraperitoneal dissemination even if the tumor is malignant. Chemotherapy can be administered before surgery if malignancy is detected. In summary, TVCNB is a useful alternative method for conducting exploratory operations.
要旨
症例は40代,2経妊2経産2回の帝王切開歴あり,子宮筋腫卵巣嚢腫の手術で強度癒着,凍結骨盤が確認されていた。その後,残存した卵巣嚢腫の悪性が疑われ卵巣癌の標準治療として試験開腹術を検討したが,経腟超音波ガイド下針生検を先行すると病理組織診で悪性が確定した。術前化学療法を行うことで,術後の腸管尿路系合併症を最小限に抑えた。このような症例に対して,経腟的卵巣嚢腫針生検は試験開腹術の代替え検査法として有用である。