Complete resection of an endometrial cancer lesion by hysteroscopic tumor resection combined with photodynamic diagnosis: a case report

Introduction: Treatment for early endometrial cancer (EC) has been shifting to less invasive surgery, including several reports of hysteroscopic tumor resection. Complete tumor resection is desired in these treatments. Photodynamic diagnosis (PDD) is the technique to increase the complete resection rate by red fluorescence of the lesion and has improved the prognosis of cystoscopic tumor resection for early bladder cancer. In gynecology, we showed that hysteroscopic PDD has high sensitivity for EC. Here, we report a case of EC in which no residual malignant lesions were found pathologically in hysterectomy after hysteroscopic tumor resection with PDD. Case: The patient was 54 years old when she was diagnosed with atypical endometrial hyperplasia by endometrial biopsy, but suspected to have EC on magnetic resonance imaging. Hysteroscopic tumor resection was planned for the definitive diagnosis. PDD was used in hysteroscopic surgery after informed consent was obtained. Under hysteroscopy, a tumefactive lesion was found on the anterior wall of the uterine cavity to near the left oviductal orifice, and was PDD-positive. The PDD-positive lesion was resected completely under hysteroscopy. The hysteroscopic specimen was pathologically diagnosed as endometrioid carcinoma, grade 1. Laparoscopic hysterectomy and bilateral salpingo-oophorectomy were then performed, but no residual malignancy was found in resected specimens. There has been no recurrence at one year after surgery without no adjunct therapy. Conclusion: Complete resection of endometrial cancer was achieved by hysteroscopic tumor resection with PDD. This case suggests that hysteroscopic surgery may be a less invasive treatment option for early EC.

Endometrial cancer; Hysteroscopy; Photodynamic diagnosis; 5-aminolevurinic acid.

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