General Gynecology · Gynecologic Oncology
RRM Academy Synopsis
Systematic laparoscopy mapping found 4 rare cancers in one series
This case series covers four patients of one surgeon who had surgery for pain or infertility. Systematic mapping during laparoscopy found rare cancers incidentally among these patients over 3 years. All four patients were cured by surgery after further work up. Three of the four cancers were neuroendocrine tumors of the appendix.
Key Findings
- The four cancers were a 2 mm well-differentiated papillary mesothelioma (WDPM) on the right pelvic sidewall and three neuroendocrine tumors, found over 3 years.
- One patient had a stage IV appendix neuroendocrine tumor measuring 2.5 cm and 2 cancerous pelvic specimens of 0.3 to 0.8 cm. After hemicolectomy, she was in remission at two years.
- The author puts the incidence of appendix neuroendocrine tumors at 0.95 in 100,000. By her rough estimate, one surgeon finding 3 of them would be very unlikely.
- A 27-year-old with dysmenorrhea, seen for a second opinion after endometriosis surgery, had a 0.5 mm well-differentiated neuroendocrine tumor with free margins and negative lymph nodes.
- A patient advised to have a hysterectomy had a 1.5 cm grade 1 appendix neuroendocrine tumor and bilateral endometriomas. She achieved spontaneous pregnancy after excision surgeries, adhesion prevention and supplementation.
Interpretation
The report is a conference abstract of a retrospective case series: four patients, one surgeon, 3 years, two years of follow-up. A case series has no comparison group, so it cannot show that the mapping techniques caused these cancers to be found. The author suggests technique may matter, these cancers may be more common than recognized, or endometriosis, infertility or common exposures could be risk factors. She notes the literature reports no such risk factors. The report gives no total for the patients operated on, so her estimate has no patient count behind it.
RRM Context
Restorative reproductive medicine looks for the cause first. Diagnostic laparoscopy is where that search happens during surgery. The author coined the term S-MAP for a mapping sequence in the NaProTechnology textbook. She calls for standard criteria so other physicians can repeat the method and gather comparable data.
Abstract not indexed.
