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“…Neuropelveology, an approach which identifies the neurologic pathway and the level of lesion with subsequent evaluation of the anatomical location of the disease, could be a new significant resource in the preoperative case preparation. With improved diagnostic accuracy and lesion expansion localization, the neuropelvelogic findings could help tailor the treatment and choose the most appropriate surgical approach [11, 20, 21]. In this context, in our case neuropelveologic assessment was suggestive of a sacral plexus involvement at a point between the supracardinal and the infracardinal level of sacral nerve roots with partial involvement of the autonomic innervation.…”
Section: Discussionmentioning
confidence: 74%
“…The incorporation of neuropelveology in cases of malignant endometriosis involving the lateral pelvic side wall could be necessary to ensure adequate surgical planning [13]. Moreover, in an effort to provide an innovative surgical approach to achieve complete resection in this subset of patients, L-LEER, based on the ontogenetic compartment theory, has been proposed [12, 20, 21]. In addition to definitive surgery, a regime of paclitaxel and carboplatin or cisplatin has been described as the treatment with best outcomes [8, 14].…”
Introduction: Squamous cell carcinoma (SCC) arising from endometriosis is very rare. Moreover, endometriosis located on the pelvic side wall is uncommon, while its cancerization is quite unusual. We herein report the first case of retroperitoneal SCC arising from endometriosis.
Case Presentation: A case of 52-year-old woman with retroperitoneal pararectal right mass is presented. The pelvic magnetic resonance imaging showed a retroperitoneal tumor extended to the right pelvic side wall. The neuropelveological examination completed the preoperative assessment, showing a right-sided sciatica and overactive bladder symptoms. Tumor removal was completely managed by minimally invasive technique through laparoscopic laterally extended endopelvic resection (L-LEER) procedure and pelvic neurolysis. Final histology revealed a SCC in a context of diffuse endometriosis with a histologic continuity between the SCC and the endometriosis. The patient underwent adjuvant chemotherapy with no recurrence after six months.
Discussion/Conclusion: To the best of our knowledge, the present case represents the first evidence of retroperitoneal SCC of the pelvic side wall arising from endometriosis completely resected by laparoscopic approach. Although its rare occurrence, the gynecologist oncologist should maintain a high index of suspicion for malignant endometriosis transformation in case of retroperitoneal pelvic mass and history of endometriosis.
“…Neuropelveology, an approach which identifies the neurologic pathway and the level of lesion with subsequent evaluation of the anatomical location of the disease, could be a new significant resource in the preoperative case preparation. With improved diagnostic accuracy and lesion expansion localization, the neuropelvelogic findings could help tailor the treatment and choose the most appropriate surgical approach [11, 20, 21]. In this context, in our case neuropelveologic assessment was suggestive of a sacral plexus involvement at a point between the supracardinal and the infracardinal level of sacral nerve roots with partial involvement of the autonomic innervation.…”
Section: Discussionmentioning
confidence: 74%
“…The incorporation of neuropelveology in cases of malignant endometriosis involving the lateral pelvic side wall could be necessary to ensure adequate surgical planning [13]. Moreover, in an effort to provide an innovative surgical approach to achieve complete resection in this subset of patients, L-LEER, based on the ontogenetic compartment theory, has been proposed [12, 20, 21]. In addition to definitive surgery, a regime of paclitaxel and carboplatin or cisplatin has been described as the treatment with best outcomes [8, 14].…”
Introduction: Squamous cell carcinoma (SCC) arising from endometriosis is very rare. Moreover, endometriosis located on the pelvic side wall is uncommon, while its cancerization is quite unusual. We herein report the first case of retroperitoneal SCC arising from endometriosis.
Case Presentation: A case of 52-year-old woman with retroperitoneal pararectal right mass is presented. The pelvic magnetic resonance imaging showed a retroperitoneal tumor extended to the right pelvic side wall. The neuropelveological examination completed the preoperative assessment, showing a right-sided sciatica and overactive bladder symptoms. Tumor removal was completely managed by minimally invasive technique through laparoscopic laterally extended endopelvic resection (L-LEER) procedure and pelvic neurolysis. Final histology revealed a SCC in a context of diffuse endometriosis with a histologic continuity between the SCC and the endometriosis. The patient underwent adjuvant chemotherapy with no recurrence after six months.
Discussion/Conclusion: To the best of our knowledge, the present case represents the first evidence of retroperitoneal SCC of the pelvic side wall arising from endometriosis completely resected by laparoscopic approach. Although its rare occurrence, the gynecologist oncologist should maintain a high index of suspicion for malignant endometriosis transformation in case of retroperitoneal pelvic mass and history of endometriosis.
“…NP is a discipline focused on its management, as it constitutes one of the main reasons for gynecological consultation, with a worldwide prevalence of approximately 12% of the population. This discipline aims to locate the pain and its etiology through the use of resources such as clinical examination, ultrasound, magnetic resonance imaging, and laparoscopic exploration for its proper approach and classification [2,47,48].…”
nerve injuries associated with chronic pelvic pain (CPP), which is the main symptom for which patients seek gynecology services.CPP affects multiple organs due to the connection of the intrapelvic organs and their innervation with the autonomic and somatic nerve plexuses. Therefore, NP involves a multidisciplinary approach, primarily neurological, gynecological, neurosurgical, urological, and colorectal. Objective: To understand the general aspects of NP and its application in CPP. Methods: A systematic search was conducted in Pubmed using the following keywords: Neuropelveology, chronic pelvic pain, and pelvic nerves. The inclusion criteria were as follows: availability of the text and original and review articles with publication dates from 2008 to 2023, excluding articles that were not in English and not indexed. Results: We described the most important endpoints of NP found in the literature and made a table to understand the importance of NP in CPP.
“…After the resection of the first mass, extensive neurolysis of all sacral routes, obturator nerve, pudendal nerve till the entrance of the pudendal (Alcock) canal, and sciatic nerve was performed (Fig. 4 a), as previously described [ 7 ]. Fig.…”
Background
Pheochromocytoma and Paraganglioma (PGL) are rare neuroendocrine tumors, with an estimated incidence of about 0.6 cases per 100.000 person/year. Overall, 3–8% of them are malignant. These tumors are characterized by a classic triad of symptoms (headaches, palpitations, profuse sweating) due to hypersecretion of catecholamines. Despite several advantages of minimally invasive surgery (MIS) for PGL debulking, the surgical approach is not standardized yet. In this scenario, we aimed to report a case of a multiple recurrent PGL with metastatic retroperitoneal localization involving the pelvic sidewall, excised with MIS.
Case presentation
We performed complete laparoscopic-assisted neuronavigation (LANN technique) with isolation of the sacral routes and the sciatic nerve to obtain complete exposure of the main anatomic landmarks. Robotic surgery was used to perform neurolysis of sacral plexus, and partial resection of left splanchnic nerves was needed. After the resection of the first mass, extensive neurolysis of all sacral routes, obturator nerve, pudendal nerve till the entrance of the pudendal (Alcock) canal, and sciatic nerve was performed. Finally, the mass was identified after trans gluteal incision and dissection of the maximum gluteal muscle, and a partial resection of the superior gluteal nerve and slicing of the sciatic nerve were needed to obtain a radical excision of the mass. Then neurorrhaphy of the sectioned nerve fibers of the superior gluteal nerve was performed, and nerve protection was obtained using a collagen nerve wrap. After 18 months of follow-up, the patient is free of disease at the MRI imaging and 123I-metaiodobenzylguanidine scintigraphy.
Conclusions
Minimally invasive gynecological surgery with neuropelveological approach could be considered as a feasible option in case of multifocal pelvic retroperitoneal malignant paraganglioma of the pelvic side wall.
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