Introduction Intravenous leiomyomatosis (ILV) is a rare pathology, part of leiomyoma beyond the uterus (LBU), characterized by benign smooth muscle cell tumor outside of the uterus and mainly affecting premenopausal woman with a medical history of leiomyoma or gynecologic surgical treatment. The treatment depends on the localization of the tumor, age of the patient, initial size, symptoms and the suitability for surgery but should always aims in toto surgical resection. Case presentation Retrospective case series and review of literature. Clinical discussion Symptoms presented by the patient were aspecific and only localized in the pelvic area. All cases were fortuitous histopathological diagnosis. No relapse was. Two out of 5 patients have pulmonary nodules, only one was biopsied and diagnosed with PBML (pulmonary benign metastasizing leiomyoma). Conclusion IVL and BML are rare disease that can co-exist. Because of tumoral hormonal receptors, hormonotherapy could be an optional treatment but to date no clear efficacy is demonstrated. In case of high recurrence risk such as voluminous initial mass, impairment of broad ligament, failure of total surgical resection, adjuvant hormonotherapy could be useful. Recurrence rate is about 16.6-30% and can occur even dozen years later and even after radical surgery, justifying a regular follow up.

Endometrial cancer is the most commonly diagnosed gynecological malignancy. Feasibility and safety of laparoscopy are no longer to be demonstrated in patients with uterine-confined endometrial carcinoma. Vaginally assisted natural orifices endoscopic transluminal endoscopic surgery (vNOTES) is a new endoscopic approach over the past decade with significant evidence in benign pathology. Publications exploring VNOTES surgery in gynecological cancer were published first in 2014. We hereby report our first experience with vNOTES surgery in endometrial cancer. A 64-year-old patient presented with postmenopausal bleeding. Endometrial biopsy identified a G1 endometrioid adenocarcinoma. MRI suspected deep invasion of myometrium with no abnormal lymph node. She underwent a total hysterectomy with bilateral adnexectomy and retroperitoneal pelvic sentinel node biopsy by vNOTES. The final histopathology confirmed G1 endometrial adenocarcinoma FIGO II (proximal focal invasion of cervical stroma and superficial invasion of myometrium). The patient was discharged 2 days postoperatively with no complications. vNOTES offers a closer approach and a better view of afferent lymphatics and probably the best chances to identify the true sentinel node. This approach presents several advantages compared to abdominal laparoscopy such as faster postoperative recovery, reduced pain, decreased postoperative wound infections, and no abdominal trocar port complications. The future research should focus on oncological safety, accuracy, and reliability of this technique, and an international registry should help to gather rapidly these informations.