It is suggested that surgery with systematic pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy could improve long-term survival in patients with PAN metastasis, although there are only 21 patients with PAN metastasis.

We report a case of microcystic stromal tumor (MCST) resected by laparoscopy. MCST is a very rare ovarian tumor with distinctive microcystic features and a characteristic stromal tumor immunopheno-type. The present case was a 26-year-oId woman who underwent laparoscopic surgery for suspected endometrial cyst of the left ovary. The mass was 8 cm in size and contained bloody fluid, and after attempting cystectomy, we eventually performed left salpingo-oophorectomy with a final postoperative pathological diagnosis of MCST. Although MCST has not yet been associated with malignancy, there are reported links to mutations in the β-catenin gene, and long-term prognosis is still unknown. As MCST resection by laparoscopy has not yet been fully described in the literature, the current case provides an example of when an unexpected, potentially malignant mass is encountered during routine cystectomy and details its subsequent management laparoscopically.

Laparoscopic techniques have evolved from predominantly diagnostic to extensive operative procedures. Surgical techniques traditionally performed in an open fashion are being conducted laparoscopically with increasing frequency. With these developments, the indications for laparoscopic suturing have increased accordingly. Caution is required to avoid breaking or losing a needle during extracorporeal suturing. We describe the breakage and subsequent recovery of 1.5 mm segments of surgical needles during a laparoscopic myomectomy and a total laparoscopic hysterectomy. Most current research has focused on preventative and detection strategies for lost needles; however, there are no known methods of completely preventing occurrences of these unforeseen events. In this paper, we discuss a literature review of needles lost during laparoscopic surgery.

Introduction: Despite reports of pseudo lymphovascular space involvement (LVSI) in total laparoscopic hysterectomy (TLH) in recent years, we recently experienced a misdiagnosis of pseudo-LVSI after TLH for uterine myoma, having observed irregularities in excised specimens. Additional surgery found no abnormalities, resulting in an unfortunate case of overtreatment. For this reason, we reviewed cases of TLH for benign uterine disorders performed at our hospital for the presence of similar pseudoinvasion. Case Description:We re-examined 53 cases for the presence of intravascular endometrial tissue from patients who had undergone TLH for benign uterine disorders. In a 42-year-old patient who had undergone TLH for uterine myoma, we found a small amount of complex atypical endometrial hyperplasia and observed intravascular agglomerations of atypical endometrial cells at multiple sites, leading to a diagnosis of LVSI. We performed additional surgery (laparotomy), but findings were unremarkable. Pseudo-LVSI was identified in 8 of 53 cases (15.1%): in 2 of 21 (9.5%) operations performed with the ClearView uterine manipulator and in 6 of 32 (18.8%) performed with the Vcare uterine manipulator. Discussion: Differentiation between "true" LVSI and grossing artifacts remains difficult, and a noteworthy case of overtreatment such as this highlights the need to reinstitute differentiation as a salient topic of discussion among surgeons and pathologists. Similarly, the existence of pseudoinvasion in a significant number of the retrospectively reviewed cases, in light of its still-undetermined clinical significance, is an interesting finding that warrants additional investigation to avoid both overtreatment and undertreatment of such cases.

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