Category: Laparoscopy: Lower Tract - Malignant

VS11-10 - Hand-assisted laparoscopic surgery for primary leiomyosarcoma of the seminal vesicle

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Primary leiomyosarcoma of the seminal vesicle is an extremely rare disease. There are only eight cases reported in English literatures. Radical excision is the best method for disease management while the benefit of adjuvant or neoadjuvant treatment is uncertain. Herein we report the ninth case of primary leiomyosarcoma of the seminal vesicle and the first case undergoing surgical resection by hand-assisted laparoscopic approach.


Methods :

A 62-year-old man was found to have a  pelvic mass measuring 9cm*6cm*7.5 cm by magnetic resonance imaging(Figure 1). He received transrectal ultrasound guided biopsy and leiomyoscarcoma was confirmed by pathology report. A series of imaging examination was arranged to exclude lymphadenopathy and distal metastasis. He underwent hand-assisted laparoscopic tumor excision, seminal vesicle resection and partial cystectomy. The total operative time was 105 minutes and the total intraoperative blood loss was 100 mL. Time to flatus was 36 hours. The patient evolved with an uneventful postoperative period, and the total hospital stay was 9 days.


Results :

Immunohistochemical stain of the tumor, measuring 9.5cm* 7.8cm* 5.2cm, showed positive results for smooth muscle actin, desmin, and Ki-67 while negative results for CD 34, CD 117, S-100, and DOG-1. Primary leiomyosarcoma of the seminal vesicle was confirmed by pathology report. Adjuvant radiotherapy was conducted 2 months after surgery. Abdominal computed tomographywas performed 5 months after surgery. Multiple metastatic lesions at liver were found and metastatic leiomyosarcoma was confirmed by pathology. The patient was referred to oncology department for adjuvant chemotherapy using ifosfomide regimen.


Conclusions : Due to the rarity of the disease, data on optimal treatment are limited. Including radical vesiculo-prostatectomy and radical cystoprostatectomy, the main treatment is surgery. Radical excision is the best chance for cure. Our report suggests that hand-assisted laparoscopic approach is a safe, feasible, and effective approach for the treatment of primary leiomyosarcoma of the seminal vesicle.

Shu-Wen Li

Renai Branch, Taipei City Hospital
Taipei, Taipei, Taiwan (Republic of China)

Shu-Wen, Li
Resident of urology department, Taipei City Hospital, Taiwan
Email: carol780422@hotmail.com

Thomas Y. Hsueh

Chief
Division of Urology, Department of Surgery, Ren-ai Branch, Taipei City Hospital
Taipei, Taipei, Taiwan (Republic of China)

Thomas Y. Hsueh MD. PhD, Chief, Division of Urology, Department of Surgery, Taipei City Hospital, Ren-Ai branch

Allen W. Chiu

Professor
Department of Urology, School of Medicine, National Yang-Ming University
Taipei, Taipei, Taiwan (Republic of China)