Title:  A Case of Curative Surgery of Metastatic Appendiceal Cancer by a General Gynecologist Due to “Near-Contact” Laparoscopy and Systematic Mapping of the Abdomen and Pelvis

Summary: 33 year old G3P2012 who presented with long, irregular cycles, abnormal uterine bleeding, dysmenorrhea, continuous mucus discharge, and infertility. She had an elevated 17OHP of up to 988 and Non-classic congenital adrenal hyperplasia was ruled out by endocrinology and she was diagnosed with PCOS. She had bilateral PCO appearing ovaries on ultrasound which were enlarged and a greater than 2:1 reversal of her LH: FSH ratio as well as elevated testosterone. Ultrasound demonstrated bilaterally enlarged polycystic appearing ovaries but otherwise was normal.

Surgical findings included: enlarged uterus (suspicious for adenomyosis), endometriosis on bladder/uterus/posterior uterus/posterior broad ligaments/posterior cul de sac, left paratubal cyst, right ovarian cyst, enlarged bilateral polycystic appearing ovaries, bilaterally partially obstructed fallopian tubes, mass on appendix, and grade III cervical ectropion.

She underwent: Hysteroscopy, endometrial and endocervical cultures and biopsies, selective hysterosalpingogram, bilateral tubal cannulation, diagnostic laparoscopy, robotic assisted bilateral ovarian wedge resection, laser surgery for endometriosis, appendectomy, cauterization of cervical ectropion, and adhesion prevention measures. Diagnostic laparoscopy was performed using “near-contact” laparoscopy and systematic mapping of the abdomen and pelvis techniques.

On pathology, she was found to have Stage IV well differentiated Neuroendocrine tumor (grade 1) of appendix due to the appendiceal mass of 2.5 cm plus 2 specimens from the pelvis also being positive for cancer (3 specimens measuring 0.3 to 0.8 cm per path report).

She subsequently underwent hemicolectomy surgery. The 27 lymph nodes and margins as well as her pelvis were negative for disease, and the oncologist determined that no chemotherapy or radiation was indicated. She was monitored for 2 years until she was determined to be in remission. Instructions were to strongly avoid pregnancy to be able to do serial CT imaging and ensure clearance of disease. She used the Creighton Model FertilityCare System ™ as well as “family planning progesterone” aka early luteal phase progesterone monitoring which has been shown to be highly effective at avoiding pregnancy (0 pregnancies in 605 cycles or 50 equivalent years). PMID: 32431450

During the time of surveillance, her mother (age 64) was diagnosed with breast cancer and she and the patient were found to have a genetic mutation (ATM gene) which increases her risk of breast cancer (~25% chance) and now she will have close surveillance with MRI vs mammogram every 6 months. She is planning to have her children tested as well.

Conclusion: The utilization of “near-contact” laparoscopy (NCL) and systematic abdominal and pelvic mapping (S-MAP) techniques led to an incidental curative surgery of a rare, advanced stage cancer by a non-oncologic general gynecologist.

Accepted for Poster Presentation: September 1, 2023.
Presented: September 29-30, 2023.

Corresponding Author: Naomi Whittaker, MD. UPMC Divine Mercy Womens Health, PA, USA. (naomimwhittaker@gmail.com)

Conflict of Interest Disclosures: No disclosures or fees were reported or received.

Cite: Whittaker, N. (2023, September 29-30). A Case of Curative Surgery of Metastatic Appendiceal Cancer by a General Gynecologist Due to “Near-Contact” Laparoscopy and Systematic Mapping of the Abdomen and Pelvis, [Conference poster presentation abstract]. Revitalizing Women's Healthcare Together. Minneapolis, MN, USA.