Laterally extended endopelvic resection as part of the surgical management of disseminated retroperitoneal leiomyomatosis mimicking low-grade sarcoma in a patient with a solitary kidney

Abstract

Leiomyomas are common benign uterine smooth muscle tumours. Rarer subsets may demonstrate aggressive extrauterine growth which mimic metastatic disease. We discuss the case of a female patient in her 40s, with a long-standing atrophic right kidney, presenting with a 17 cm uterine mass demonstrating bilateral para-aortic and pelvic sidewall spread. Although biopsies favoured the diagnosis of a benign tumour, a leiomyosarcoma could not be excluded. The surgical complexity of the case was compounded by a tumour residing close to the only functioning kidney and engulfment of the inferior mesenteric artery. The surgical procedures indicated were a radical hysterectomy, the laterally extended endopelvic resection procedure to achieve clear margins in the pelvic sidewall and a left hemicolectomy. In the absence of formal guidelines, we present this challenging case to provide clarity into the histological assessment and surgical management of rare leiomyomas, as well as an overview of the current literature.

Radical Total Pelvic Exenteration with Concomitant Right Nephrectomy in the Management of Recurrent Endometrioid Ovarian Adenocarcinoma: A Case Report and Literature Review

“…Until new treatments options are identified, surgery with maximal cytoreductive effort remains the mainstay treatment for this histological subtype of ovarian cancer [17][18][19][20][21][22][23][24][25]. Achieving resection of all macroscopic disease (R0) is the single independent factor for survival.…”

Radical total pelvic exenteration with concomitant right nephrectomy in the management of recurrent endometrioid ovarian adenocarcinoma: A case report and literature review

“…Until new treatments options are identified, surgery with maximal cytoreductive effort remains the mainstay treatment for this histological subtype of ovarian cancer. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 Achieving resection of all macroscopic disease (R0) is the single independent factor for survival. In their meta‐analysis including 6885 patients with advanced ovarian cancer, Bristow et al (2023) have shown there is a 5.5% increase in median survival time with each 10% increase in maximal cytoreduction.…”

The role of the multidisciplinary team in surgical management of intractable tubo‐ovarian abscess as a late sequelae of challenging Crohn's disease in the modern era: A case report and review of current literature

“…These complications were managed by further procedures alongside years of antibiotics and immunosuppressants without success, and still further exacerbated by delays in treatment, as teams were hesitant to intervene on such a hostile abdomen. This highlights the paradigm of surgical challenge in Crohn's disease wherein the disease complicates the surgery and the surgery complicates the disease 4 . This case highlights how a disease that is assumed to largely affect the gastric system can go on to cause dysfunction across the bio‐psychosocial health of an individual.…”

“…This highlights the paradigm of surgical challenge in Crohn's disease wherein the disease complicates the surgery and the surgery complicates the disease. 4 This case highlights how a disease that is assumed to largely affect the gastric system can go on to cause dysfunction across the bio-psychosocial health of an individual. Finally, our successful management of this case identifies how definitive treatment is often necessary to improve a patient's quality of life and how a multidisciplinary approach is needed to provide such treatment.…”