A case of uterine endometrioid adenocarcinoma diagnosed after laparoscopic supracervical hysterectomy and sacrocolpopexy for pelvic organ prolapse

Since the Food and Drug Administration warning in 2011 against transvaginal mesh operation for pelvic organ prolapse, this operation is avoided owing to its severe complications. Instead, laparoscopic sacrocolpopexy (LSC) is selected by many urogynecologists. For the strong attachment between the cervix and mesh, supracevical hysterectomy is usually performed before LSC. Uterine removal from the intra-abdominal space requires intraperitoneal shredding or morcellation of the specimen. In cases of unexpected uterine malignancy, shredding or morcellation of the uterine specimen may interfere with the appropriate staging and increase the risks of malignant cell dissemination. We here report a case of uterine endometrioid adenocarcinoma diagnosed after supracervical hysterectomy and sacrocolpopexy for pelvic organ prolapse. The patient was 49 years old (gravida 4, para 2). She underwent laparoscopic supracervical hysterectomy and LSC for pelvic organ prolapse. Preoperative transvaginal ultrasound did not show thickening of the endometrium, and the endometrial cytology was negative. However, the pathologic examination after the initial operation showed uterine endometrioid adenocarcinoma, stage I. Accordingly, she was referred to our hospital and underwent trachelectomy, pelvic lymph node dissection, and paraaortic lymph node biopsy. This case indicates that we need to be aware of the possibility of uterine malignancy in cases of laparoscopic supracervical hysterectomy and LSC.