[A case of poorly differentiated adenocarcinoma of the uterine cervix treated with paclitaxel and carboplatin after positive PAX 8 immunostaining].

PAX 8 is a paired-box gene that plays an important role in the embryogenesis of the thyroid gland, Müllerian ducts, and renal/upper urinary tract. PAX 8 expression is observed in carcinomas from each of these sites. Accordingly, PAX 8 immunostaining has been reported to be useful for the diagnosis of these carcinomas. Here, we report a case in which PAX 8 was useful for the diagnosis of a patient with cervical adenocarcinoma and multiple metastases. A 55-year-old female patient complained of cough and genital bleeding. Examination revealed a uterine cervical mass, masses in both breasts, and enlargement of the lymph nodes and subcutaneous nodules. Histology of the uterine cervical mass biopsy revealed a poorly differentiated adenocarcinoma. Cytology of the aspiration biopsy specimens of the breast masses indicated scirrhous cancer. PAX 8 immunostaining of the uterine cervical mass and breast mass biopsies was positive. We determined that the breast masses were metastases of the cervical adenocarcinoma and decided to treat the patient with chemotherapy consisting of paclitaxel and carboplatin. A partial response was observed. A hysterectomy was performed 5 months after chemotherapy because corpus cancer was newly diagnosed. The cervical adenocarcinoma was undetectable in the surgical specimen. Fifteen months have passed since the completion of chemotherapy and the metastases has been under control.

A case in which laparoscopic right salpingo-oophorectomy was performed in a patient with a lumboperitoneal shunt.

INTRODUCTION: Ventriculoperitoneal (VP shunts) and lumboperitoneal shunts (LP shunts) are used to treat hydrocephalus. The effectiveness of LP shunts has recently been demonstrated. Due to population aging, the number of patients with LP shunts is expected to increase. PRESENTATION OF CASE: A 51-year-old female, in whom an LP shunt had been inserted to treat hydrocephalus after a subarachnoid hemorrhage, underwent laparoscopic right salpingo-oophorectomy for a right endometriotic cyst. We consulted a neurosurgeon and confirmed the route of the shunt. We started a normal laparoscopic procedure. The head of the shunt tube was located in Douglas' pouch and was an obstacle to the procedure. We moved the head of the shunt tube to the vesicouterine pouch and successfully conducted the standard operation. We report the case together with a literature review. DISCUSSION: There have been several reports about gynecological laparoscopic surgery being performed in patients with VP shunts. On the other hand, we did not find any English literature about gynecological laparoscopic surgery being conducted in patients with LP shunts during a PubMed search. CONCLUSION: This is the first report about gynecological laparoscopic surgery being performed in a patient with an LP shunt.