Delayed and clinically isolated port site carcinosarcoma recurrence as an early indicator of disseminated disease

Abstract

A 71-year-old woman with suspected endometrial cancer underwent robotic-assisted hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection, and infracolic omentectomy revealing a stage II uterine carcinosarcoma with components of serous adenocarcinoma and undifferentiated spindle cell sarcoma. There was no evidence of distant metastasis at the time of surgery. However pelvic washings were positive for malignant cells. She received adjuvant chemotherapy and vaginal cuff brachytherapy. Forty months later she developed a subcutaneous mass at the location of previous port site which was confirmed to be recurrence of the uterine primary. She subsequently developed additional distant metastases to the abdominal wall, lungs, and bone. Port site metastasis (PSM) was the earliest indicator of disseminated metastatic disease in this patient. We review challenges in the management of patients with PSM and propose that PSM be considered as a sign of systemic disease even when presenting as an apparently isolated recurrence.

Port Site Metastasis After Minimally Invasive Surgery in Gynecologic Malignancies: Two Case Reports and a Review of the Literature

“…In our retrospective analysis, we found that PSM in most case reports occurred more frequently in the incision lower abdomen rectus abdominus of bilateral inguinal regions and pubic symphysis. [25][26][27][28] PSM around the umbilicus or epigastrium is rare. 29,30 Whether the puncture point near the tumor is more likely to cause implant metastasis remains unknown and needs further study.…”