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Laparoscopic Approach To Obturator Lymph Node Positivity in Positron Emission Tomography Assisted Computerized Tomography (PET-CT) of a Preoperative Stage 1B1 Cervical Cancer PatientAhmet Cem İyibozkurt, Özlem Çınar Dural, Samet Topuz, Selen Gürsoy, Ayşe Filiz Gökmen, Sinan BerkmanDepartment Of Obstetrics And Gynecology, Istanbul Faculty Of Medicine, Istanbul University, Istanbul, TurkeyObjektive: Although positron emission tomography assisted computerized tomography (PET-CT) is used to evaluate staging, treatment planning and prognosis in cervical cancer, its definite role is not established. It is especially used to rule out lymph node and distant metastasis in early stage cervical cancer patients who are candidates for radical hysterectomy. Recent literature suggests that by doing so unnecessary surgery, in patients who will ultimately require radiotherapy, would be prevented. We are presenting a case of cervical cancer patient preoperatively staged as 1B1 but revealed a lymph node positivity in PET-CT scan in left obturator fossa. She had a laparoscopic lymph node dissection and frozen section. Setting: University clinic. Results: A 52-year-old postmenopausal woman with a complaint of frequent spotting was diagnosed to have stage 1B1 squamous carcinoma of the cervix of 1.5 cm in diameter. Her preoperative PET-CT revealed a positivity in left obturator fossa suggesting metastasis in addition to cervical uptake. She was planned to have a radical hysterectomy if laparoscopic lymph node dissection and frozen section were negative for malignancy. Intra-operative frozen section of a 1 cm lymph node from the left obturator fossa was positive for metastasis. The decision of radical hysterectomy was abandoned and she was referred to concomitant chemoradiotherapy. Interestingly, her final pathology revealed an additional microscopic metastasis in one of right pelvic lymph nodes that was sampled during the operation. Conclusions: If PET-CT scan is negative for lymph node metastasis, these patients have low risk for postoperative radiotherapy after radical hysterectomy. In accordance with current literature, microscopic lymph node metastasis may not be revealed by PETCT, as it was in our case. If PET-CT reveals metastatic uptake, laparoscopic lymph node sampling and frozen section may be Preoperatif Evre 1B1 Serviks Kanseri Olgusunda Hibrid Pozitron Emisyon Tomografisi – Bilgisayarlı Tomografide (PET-BT) Saptanan Pozitif Obturator Lenf Bezi Tutulumuna Laparoskopik YaklaşımAhmet Cem İyibozkurt, Özlem Çınar Dural, Samet Topuz, Selen Gürsoy, Ayşe Filiz Gökmen, Sinan Berkmanİstanbul Üniversitesi, İstanbul Tıp Fakültesi, Kadın Hastalıkları Ve Doğum Ana Bilim Dalı, İstanbulAmaç: Hibrid fluorodeoksiglukoz-pozitron emisyon tomografisi ve bilgisayarlı tomografinin (PET-BT) serviks kanserlerinde evreleme, tedavi planlaması, prognoz gibi parametrelerin değerlendirilmesinde kullanılmasına rağmen yeri netleşmemiştir. Özellikle erken evre serviks kanserlerinde radikal histerektomi planlanan hastalarda olası lenf bezi ve uzak metastazların saptanmasında kullanılmıştır. Postoperatif radyoterapi almak durumunda kalacak hasta grubunda tedavi değişiklikleri ile gereksiz operasyonların önlenebildiğini bildiren yayınlar vardır. Kliniğimizde evre IB1 değerlendirilen ve PET-BT tetkiğinde sol obturator alanda tutulum saptanarak laparoskopik lenf bezi örneklemesi ve frozen yapılan bir hastayı sunuyoruz. Ortam: Üniversite hastanesinden bir vaka sunumu. Sonuç: Lekelenme şeklinde kanamaları nedeniyle kliniğimize başvuran 52 yaşındaki hastada çapı 1.5 cm’e ulaşan skuamöz hücreli evre IB1 serviks kanseri saptandı. Preoperatif çekilen PET-BT görüntülemesinde servikse ek olarak sol obturator alanda malign karakterde tutulum bulunması üzerine hastaya laparoskopik lenf bezi biopsisi ve frozen sonrasında radikal histerektomi planlandı. Operasyonda sol obturator alandan çıkarılan 1 cm lenf bezi frozen sonucunun karsinom metastazı olarak gelmesi üzerine hastaya radikal histerektomi yapılmayarak konkomitan kemoradyoterapiye yönlendirildi. Ancak yapılan bilateral pelvik lenf bezi örneklemesi Ahmet Cem İyibozkurt, Özlem Çınar Dural, Samet Topuz, Selen Gürsoy, Ayşe Filiz Gökmen, Sinan Berkman. Laparoscopic Approach To Obturator Lymph Node Positivity in Positron Emission Tomography Assisted Computerized Tomography (PET-CT) of a Preoperative Stage 1B1 Cervical Cancer Patient. . 2008; 5(4): 269-273 Corresponding Author: Ahmet Cem İyibozkurt, Türkiye |
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