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

Abstract

Port site metastasis (PSM) is considered an uncommon and rare complication in gynecologic malignancies with unclear treatment recommendations or guidelines. Thus, we report the treatment strategies and outcomes of two cases of PSMs following gynecologic malignancies and a review of the literature to provide much information about the most frequent sites of PSMs and the incidence of PSMs in different gynecological tumors. A 57-year-old woman underwent laparoscopic radical surgery for right ovarian serous carcinoma in June 2016 followed by postoperative chemotherapy. Because PSMs were present near the port site of the bilateral iliac fossa, the tumors were completely removed on August 4, 2020, and the patient received chemotherapy. She has shown no signs of relapse. During the same period, a 39-year-old woman underwent laparoscopic type II radical hysterectomy for endometrial adenocarcinoma involving the endometrium and cervix on May 4, 2014, without adjuvant treatment. In July 2020, a subcutaneous mass under her abdominal incision was removed, and chemotherapy plus radiotherapy was administered. Metastasis was found in the left lung in September 2022, but there was no abnormality in the abdominal incision. We showed the two cases of PSMs, reviewed articles to provide some new insights about the incidences of PSMs in the gynecologic tumors, and discussed the proper preventive strategies.

Keywords: endometrial cancer; metastasis; ovarian cancer; port site.

Figure 1

Pelvic computed tomography (CT) results of the patient in Case 1 at the time of initial treatment and recurrence. (A) CT revealed a mass (13.0 cm × 6.0 cm × 3.8 cm) in the right adnexa (red arrow and yellow outline) on July 21, 2016. The boundary between the mass and uterus was clear. A liquid density shadow could be seen in the pelvic cavity. No enlarged lymph node shadow was found in the retroperitoneum or pelvic wall; (B) CT showed a nodule (3.2 cm × 3.2 cm) in the left inguinal region (red arrow and yellow outline) on June 31, 2022.

Figure 2

Gross tissue and pathological examination of the surgical samples from both sides. Two masses with irregular surfaces and slightly hard textures are shown (A). Hematoxylin–eosin (HE) staining confirmed that these specimens were tumor tissues, 20 × ((B), left side; (C), right side).

Figure 3

Imaging results of the patient in Case 2. (A) Ultrasound showed subcutaneous mass in the abdominal wall (4.1 cm × 2.2 cm) on May 21, 2020 (red arrow and yellow outline); (B) CT indicted abnormal enhanced nodule of right rectus abdominis (3.1 cm × 2.3 cm) on July 22, 2020 (red arrow and yellow outline).

Figure 4

Intraoperative photograph of abdominal wall lesions and HE staining. (A) the gross mass in the abdominal wall had a hard texture. (B) sectioning the mass confirmed that it was yellow solid tissue. (C and D) HE staining confirmed that these specimens were tumor tissues (C, 20 ×; D, 100×).

Figure 5

The percentage of patients with gynecological malignancies and PSM.