Interface site recurrence is a rare but well-documented adverse event peculiar to laparoscopic surgery. invasive nature, ovarian cancer is an exception to this pattern from the viewpoint of oncologic outcomes. The potential risk of port site recurrence (PSR) is one of the most important concerns. However, the precise mechanism of PSR has not been fully elucidated. We found several published reports discussing PSR in the PubMed database, all of which reported a low probability of PSR occurrence1,2,3,4,5). Almost all of the cases described exhibited simultaneous carcinomatosis or metastases to other sites2,3,4,5), suggesting that PSR may, in general, not be related to prognosis3,4,5). Herein we report a case of PSR followed by diffuse subcutaneous metastases after laparoscopic ovarian cystectomy performed for unforeseen early stage ovarian cancers. This is actually the initial survey demonstrating that also an extremely little bit of cancers tissue is connected with a threat of PSR, which could be a hallmark of poor prognosis, specifically in the lack of carcinomatosis order Vorinostat or various other advanced levels of cancers. Case Survey A 31-year-old Japanese girl, gravida 0, without remarkable health background, offered the issue of stomach distension. Ultrasound during initial examination uncovered a big tumor without solid element in the abdominal cavity. Preliminary laboratory exams including tumor marker profile confirmed no remarkable results: carcinoembryonic antigen (CEA) 1.0 ng/mL, cancers antigen 125 (CA125) 32.0 U/mL, and cancers antigen 19-9 (CA19-9) 15.4 U/mL. Contrast-enhanced magnetic resonance imaging (MRI) from the pelvis uncovered a 30 order Vorinostat 24 13-cm polycystic tumor without intratumoral solid element (Body 1a). Zero contrast was showed with the tumor enhancement. Predicated on the lack of malignant results, we diagnosed a harmless ovarian tumor. In the next month, a laparoscopic was performed by us still left ovarian cystectomy. The operative period was 135 a few minutes and the loss of blood was 850 mL, including intratumoral order Vorinostat liquid. At the start from the procedure, we inflated the abdominal using CO2 gas, preserving intra-abdominal pressure during pneumoperitoneum below 10 mmHg. A 3-cm incision was produced on the umbilical site, by which 5 liters of intratumoral mucinous liquid had been aspirated by rupturing straight without the wound security (Body 2). A number of the intratumoral liquid leaked in to the abdominal. Soon after, a 5-mm trocar was placed in to the lower correct abdominal, a SILSTM Interface (Covidien, Mansfield, MA, USA) was found in the umbilical site, as well as the tumor laparoscopically was resected. The excised tumor was taken out through the umbilical incision site and were harmless on macroscopic evaluation. No various other abnormal results were seen in the stomach cavity. Open up in another window Body 1 Picture of Rabbit Polyclonal to OR52A4 the tumor. Sagittal T2-weighted picture uncovered a 30 24 13-cm tumor without intratumoral solid element. Only 1 cyst was noticeable in upper component of tumor. Open up in another window Body 2 Laparoscopic still left ovarian cystectomy method. Five liters of intratumoral mucinous liquid had been aspirated by rupturing straight, order Vorinostat while umbilical incision was still left unprotected. Unlike our expectations, the tumor was diagnosed as a mucinous carcinoma rather than a benign tumor. Macroscopically, no malignant findings, including in the solid component, could be seen in the tumor. Examination of the entire specimen (109 segments in total) and histopathological analysis revealed that the majority order Vorinostat of the tumor consisted of an adenoma, but a small number of individual cells with severe atypia experienced invaded 1 mm into the stroma (Physique 3aC3c). These were 3, 4, and 10 mm in size. Open in a separate window Physique 3 Histopathological analysis of tumor. (a) Mucinous adenoma. Majority of tumor consisted of adenoma without atypia. (Initial magnification 100, H&E stain.) (b) Mucinous carcinoma with infiltrative invasion. Small number of tumor cells with severe atypia experienced invaded 1 mm into stroma in area 10.