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A Video Presentation Of Staged Resection Of Bilateral Enlarging Benign Endosalpingiosis Of The Chest A Rare Entity
Deemy Rekkas, md;
proheath waukesha memorial hospital, waukesha, WI, USA
BACKGROUND: There is limited information available on pleural/mediastinal endosalpingiosis. Endosalpingiosis primarily involves the presence of tubal-type epithelium outside the fallopian tubes and is predominanltly abdominopelvic. Thoracic occurrence specifically within the pleura/mediastinum has not been reported in the literature. This is a unique case of bilateral enlarging cystic endosalpingioses resected robotically in a staged approach for complete resection
Methods:31 year old woman with a history of right salpingo-oophorectomy, left ovarian cystectomy, omentectomy for right ovarian borderline serous cystadenoma underwent exploratory laparotomy for presumed recurrent disease with 25 cm pelvic mass, elevated CA 125 and potential liver metastases. She had multicystic lesions of the uterus,and a complex left ovarian mass involving surrounding structures and underwent a total abdominal hysterectomy, left salpingo-oophorectomy and removal of a 3 cm subdiaphragmatic implant. A larger immobile supradiaphragmatic mass was palpated above the liver which corresponded to the CT findings of metastatic liver lesions. Intraoperative cardiothoracic surgery consultation obtained. Plan for thoracic imaging after recovery, Pathology was a 25cm serous cystadenoma and diaphragmatic endosalpingiosis. CT chest showed a 3.8cm left cardiophrenic cystic mass near the left ventricle and 7.3cm multiloculated right diaphragmatic cystic mass. MRI chest showed lobulated pleural based 8.9cmx 8.7cmx 5cm multiloculated right hemidiaphragmatic mass and 2cm left prepericardial cystic mass. Robotic left anterior mediastinal cystic resection with 3 port technique done. Pathology was 3.2cmx 2.7cm x 1.3cm cystic endosalpingiosis. Follow up CT chest showed right pleural based mass on diaphragm increased in size to 9.2cmx 9cmx12cm, no left recurrence. She underwent robotic right resection by aspirating/ decompressing for resection in controlled fashion. Broad based pedicle from the diaphragm was transected with the vessel sealer for complete excision. Pathology was 11.2cmx7.2cmx 4.5cm benign cystic endosalpingiosis.
RESULTS: Utilizing staged robotic approach, bilateral mediastinal cystic masses were excised. The left side was done first given proximity to the left ventricle. Patient was discharged home on post op day one for each case and final pathology was benign endosalpingiosis consistent with prior pelvic pathology.
CONCLUSIONS: Successful staged robotic resection of bilateral thoracic cystic endosalpingiosis can done safely. This finding or procedure has not been reported in the literature.
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