OJOG  Vol.10 No.3 , March 2020
Total Laparoscopic Hysterectomy for Diagnosis and Treatment of Cervical Cystic Lesions: A Case Series
Abstract: Objective: Cervical cystic lesions are often observed in gynecological clinical practice. Many are caused by benign diseases such as lobular endocervical glandular hyperplasia (LEGH), and it is important to differentiate these lesions from those due to malignant diseases such as minimal deviation adenocarcinoma (MDA). In cases in which fertility preservation is not a concern, the final pathology is often confirmed by hysterectomy. To investigate the feasibility and safety of laparoscopic surgery for cervical cystic lesions, we retrospectively examined cases in which total laparoscopic hysterectomy (TLH) was performed for diagnosis and treatment. Methods: The subjects were 28 women who underwent TLH from April 2012 to March 2017 at Keio University Hospital. The pre- and post-operative courses of these patients were examined. Results: The average age was 49.4 (range 39 - 65) years and the mean body mass index was 21.7 (16.8 - 30.5) kg/m2. The average operation time was 159 (101 - 314) min and the average bleeding volume was 106.8 (0 - 600) g. There were no severe perioperative complications. The average hospital stay was 8.4 (7 - 14) days. In postoperative pathological diagnosis, 13 cases had benign diseases such as Nabot cysts, there were 14 cases of LEGH, and one patient was diagnosed with MDA. In the MDA case, additional bilateral salpingo-oophorectomy and pelvic lymph node dissection were performed at a later date. No metastasis was observed in these excised specimens. Conclusions: Our results suggest that TLH for cervical cystic lesions can be performed safely. However, it is important to consider the TLH indication before surgery based on the possibility of malignant disease.
Cite this paper: Morisada, T. , Tanaka, K. , Iijima, T. , Nishizawa, A. , Nishio, H. , Kobayashi, Y. , Nakamura, M. , Hayashi, S. , Kataoka, F. , Iwata, T. and Aoki, D. (2020) Total Laparoscopic Hysterectomy for Diagnosis and Treatment of Cervical Cystic Lesions: A Case Series. Open Journal of Obstetrics and Gynecology, 10, 357-364. doi: 10.4236/ojog.2020.1030033.

[1]   Ding, D.C., Chu, T.Y. and Hsu, Y.H. (2016) Minimal Deviation Adenocarcinoma of the Uterine Cervix: A Case Report. Tzu-Chi Medical Journal, 28, 79-81.

[2]   Mikami, Y. and McCluggage, W.G. (2013) Endocervical Glandular Lesions Exhibiting Gastric Differentiation: An Emerging Spectrum of Benign, Premalignant, and Malignant Lesions. Advances in Anatomic Pathology, 20, 227-237.

[3]   Mikami, Y. (2020) Gastric-Type Mucinous Carcinoma of the Cervix and Its Precursors: Historical Overview. Histopathology, 76, 102-111.

[4]   Talia, K.L. and McCluggage, W.G. (2018) The Developing Spectrum of Gastric-Type Cervical Glandular Lesions. Pathology, 50, 122-133.

[5]   Itoh, K., Toki, T., Shiohara, S., Oguchi, O., Konishi, I. and Fujii, S. (2000) A Comparative Analysis of Cross Sectional Imaging Techniques in Minimal Deviation Adenocarcinoma of the Uterine Cervix. BJOG: An International Journal of Obstetrics and Gynaecology, 107, 1158-1163.

[6]   Nucci, M.R., Clement, P.B. and Young, R.H. (1999) Lobular Endocervical Glandular Hyperplasia, Not Otherwise Specified: A Clinicopathologic Analysis of Thirteen Cases of a Distinctive Pseudoneoplastic Lesion and Comparison with Fourteen Cases of Adenoma Malignum. The American Journal of Surgical Pathology, 23, 886-891.

[7]   Ohya, A., Asaka, S., Fujinaga, Y. and Kadoya, M. (2018) Uterine Cervical Adenocarcinoma Associated with Lobular Endocervical Glandular Hyperplasia: Radiologic-Pathologic Correlation. Journal of Obstetrics and Gynaecology Research, 44, 312-322.

[8]   Tsuboyama, T., Yamamoto, K., Nakai, G., Yamada, T., Fujiwara, S., Terai, Y., Ohmichi, M. and Narumi, Y. (2015) A Case of Gastric-Type Adenocarcinoma of the Uterine Cervix Associated with Lobular Endocervical Glandular Hyperplasia: Radiologic-Pathologic Correlation. Abdominal Imaging, 40, 459-465.

[9]   Ando, H., Miyamoto, T., Kashima, H., Takatsu, A., Ishii, K., Fujinaga, Y. and Shiozawa, T. (2016) Usefulness of a Management Protocol for Patients with Cervical Multicystic Lesions: A Retrospective Analysis of 94 Cases and the Significance of GNAS Mutation. Journal of Obstetrics and Gynaecology Research, 42, 1588-1598.

[10]   Doi, T., Yamashita, Y., Yasunaga, T., Fujiyoshi, K., Tsunawaki, A., Takahashi, M., Katabuchi, H., Tanaka, N. and Okamura, H. (1997) Adenoma Malignum: MR Imaging and Pathologic Study. Radiology, 204, 39-42.

[11]   Takatsu, A., Shiozawa, T., Miyamoto, T., Kurosawa, K., Kashima, H., Yamada, T., Kaku, T., Mikami, Y., Kiyokawa, T., Tsuda, H., Ishii, K., Togashi, K., Koyama, T., Fujinaga, Y., Kadoya, M., Hashi, A., Susumu, N. and Konishi, I. (2011) Preoperative Differential Diagnosis of Minimal Deviation Adenocarcinoma and Lobular Endocervical Glandular Hyperplasia of the Uterine Cervix: A Multicenter Study of Clinicopathology and Magnetic Resonance Imaging Findings. International Journal of Gynecological Cancer, 21, 1287-1296.

[12]   Okuyama, R., Hashimoto, H., Miura, T., et al. (2017) Two Cases of Adenocarcinoma in Situ Arising in Lobular Endocervical Glandular Hyperplasia Indicating Localization of Mucin on the Cluster Surface as an Early Cytological Finding of Malignant Transformation. Diagnostic Cytopathology, 45, 842-847.

[13]   Phongnarisorn, C. and Srisomboon, J. (2007) Surgical Morbidity Associated with Total Laparoscopic Hysterectomy in Women with Prior Diagnostic Excision of the Cervix. The Journal of Obstetrics and Gynaecology Research, 33, 519-523.

[14]   Ramirez, P.T., Frumovitz, M., Pareja, R., Lopez, A., Vieira, M., Ribeiro, R., Buda, A., Yan, X., Shuzhong, Y., Chetty, N., Isla, D., Tamura, M., Zhu, T., Robledo, K.P., Gebski, V., Asher, R., Behan, V., Nicklin, J.L., Coleman, R.L. and Obermair, A. (2018) Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. The New England Journal of Medicine, 379, 1895-1904.

[15]   Pennington, K.P., Urban, R.R. and Gray, H.J. (2019) Revisiting Minimally Invasive Surgery in the Management of Early-Stage Cervical Cancer. Journal of the National Comprehensive Cancer Network, 17, 86-90.