Transanal total mesorectal excision for primary rectovaginal carcinosarcoma: A case report and literature review.

Abstract

We report a case of rectovaginal septum carcinosarcoma successfully treated with surgical excision via transanal total mesorectal excision following platinum-based neoadjuvant chemotherapy. A 48-year-old woman presented with a 3-week defecation pain preceding the visit. Pelvic imaging showed an 8-cm sized lesion in the lower rectovaginal septum. Transvaginal biopsy and immunohistochemical analysis were performed. After three courses of carboplatin-paclitaxel-bevacizumab therapy, the mass reduced by half. Subsequently, laparoscopic excision with transanal total mesorectal excision, and radical hysterectomy were performed. The anus was preserved, and dysuria improved within a month. The final histopathological diagnosis was carcinosarcoma of the rectovaginal septum from an uncertain origin, presumably endometriotic or mesonephric. Twelve months following surgery, solitary liver metastasis was confirmed; however, there was no evidence of local recurrence. Total mesorectal excision following platinum-based neoadjuvant chemotherapy may be an ideal treatment for gynecological malignancies in the rectovaginal septum, especially for large tumors localized deep into the pelvis.

• Authors: Takuto Onishi, Tsukuru Amano, Toru Miyake, Akiko Nakamura, Yutaka Yoneoka, Hiroki Nisimura, Shunichiro Tsuji, Masaji Tani, Takashi Murakami
• Journal: The journal of obstetrics and gynaecology research (J Obstet Gynaecol Res) Vol. 49 Issue 2 Pg. 763-768 (Feb 2023) ISSN: 1447-0756 [Electronic] Australia
• PMID: 36369664 (Publication Type: Review, Case Reports)
• Copyright: © 2022 Japan Society of Obstetrics and Gynecology.

Topics

• Female
• Humans
• Middle Aged
• Rectum (surgery)
• Rectal Neoplasms (drug therapy, surgery, pathology)
• Anal Canal (pathology, surgery)
• Laparoscopy (methods)
• Biopsy