Port site recurrence and unusual diffuse subcutaneous metastases of unexpected early stage ovarian cancer after laparoscopic surgery: a case report

Abstract

Port site recurrence is a rare but well-documented adverse event peculiar to laparoscopic surgery. We report an unusual outcome of unexpected early stage ovarian cancer in which port site recurrence occurred after laparoscopic surgery and was followed by diffuse subcutaneous metastases. A 31-year-old Japanese woman with a large tumor in her abdomen visited our hospital. Because no intratumoral solid component was detected on diagnostic imaging, the tumor was diagnosed as a benign ovarian tumor and the patient underwent left ovarian laparoscopic cystectomy. Contrary to our expectations, however, the ovarian tumor was a mucinous carcinoma. We performed additional surgery, but the tumor recurred in the umbilical area, and multiple subcutaneous metastases later appeared. The curative effect of chemotherapy and radiation was limited. This atypical metastatic distribution of an extremely small amount of cancer might have been caused by the laparoscopic procedure. Protection against tumor cell dissemination is necessary during all forms of laparoscopic surgery.

Keywords: laparoscopy; ovarian cancer; port site recurrence; subcutaneous metastases; umbilicus.

Figure 1

Image of the tumor. Sagittal T2-weighted image revealed a 30 × 24 × 13-cm tumor with no intratumoral solid component. Only one cyst was visible in upper part of tumor.

Figure 2

Laparoscopic left ovarian cystectomy procedure. Five liters of intratumoral mucinous fluid were aspirated by rupturing directly, while umbilical incision was left unprotected.

Figure 3

Histopathological analysis of tumor. (a) Mucinous adenoma. Majority of tumor consisted of adenoma without atypia. (Original magnification ×100, H&E stain.) (b) Mucinous carcinoma with infiltrative invasion. Small number of tumor cells with severe atypia had invaded 1 mm into stroma in area 10 mm in size. (Original magnification ×100, H&E stain.) (c) The invasive tumor cells. Tumor cells had nonuniformly large-sized nuclei with prominent nucleoli. (Original magnification ×400, H&E stain.)

Figure 4

Images of recurrent tumor. (a) Axial CT revealed recurrence in umbilical area. No other findings were observed in distant areas. (b) Axial CT revealed subcutaneous metastasis in right axilla (red arrow).