Partial Cystectomy for Atypical Isolated Recurrence of Ovarian Adenocarcinoma – A Case Report and Literature Review

Abstract

Ovarian cancer remains one of the most common gynecologic malignancies affecting women worldwide and is commonly diagnosed in advanced stages of the disease when disseminated lesions are already present (1). In most of these cases, although the principles of complete cytoreductive surgery are applied, relapse will occur at a certain moment. The standard treatment for these patients has widely varied in the last decades; initially it has been considered that platinum-based chemotherapy should become the standard of care for 'platinum-sensitive' recurrent tumors, while the benefits of secondary cytoreductive surgery have been considered uncertain (2). However, this theory was discarded by studies demonstrating that debulking surgery is able to increase the biological efficacy of chemotherapeutic agents by removing all bulky tumors with poor vascular supply (3). The benefits of secondary cytoreduction at the time of relapse seem to be more evident in cases presenting good performance status, early stage at diagnosis, no residual disease after primary cytoreduction, association of adjuvant chemotherapy, longer disease-free survival, normal cancer antigen (CA)-125 levels, no ascites and isolated recurrences (4-10). The good postoperative outcome reported by patients presenting isolated relapse is mainly explained by the limited number of visceral resections required to obtain complete cytoreduction, transforming these cases in perfect candidates for secondary cytoreduction (11,12). Unfortunately, it is well-known that this eventuality is a rare one as most cases present multiple recurrences necessitating an important visceral sacrifice both in the lower and upper abdomen (13)(14)(15). The aim of this work is to present the case of a 55-yearold patient diagnosed with an atypical, isolated pelvic recurrence invading the urinary bladder removed by performing a partial cystectomy three years after initial diagnosis of ovarian cancer. Case ReportA 55-year-old patient with a medical history of stage IIIC ovarian cancer presented in our service for pelvic pain and macroscopic hematuria. The patient had been submitted to cytoreductive surgery three years before; total hysterectomy with bilateral adnexectomy, pelvic, parietal bilateral peritonectomy, omentectomy, pelvic and para-aortic lymph node dissection. At that moment, an R0 resection was achieved, while the histopathological examination revealed 429 This article is freely accessible online.Correspondence to:

Anterior Pelvic Exenteration for Chemo-irradiated Non-diethylstilbestrol Exposed Clear Cell Vaginal Cancer

“…In such cases the usual development of the tumor on the anterior wall of the vagina might impose performing an anterior pelvic exenteration. Experience gained during treating stage IV cervical cancer with urinary bladder invasion or pelvic recurrences after surgically treated cervical cancer provided the opportunity to offer a radical treatment in such cases (11)(12)(13)(14).…”