Isolated vulvar metastasis after robot-assisted laparoscopic hysterectomy for low grade, early stage endometrial cancer: a case report and review of the literature

Objectives: Our objective is to report a case of isolated vulvar metastasis after robot-assisted laparoscopic hysterectomy for early-stage endometrial adenocarcinoma and to conduct a systematic review of the related literature to determine the frequency of this rare metastasis. Methods: We present a case-report of a rare vulvar metastasis and conduct a systematic review of the English literature. Results: A 74-year-old woman with suspected uterine malignancy underwent a total laparoscopic hysterectomy with specimen removal through the vagina. Pathology revealed endometrioid carcinoma (WHO-World Health Organization-categorization of endometrial cancer histology) stage IA, grade 1 (FIGO-International Federation of Gynecology and Obstetrics-categorization). Upon a 12-month clinical examination after surgery, an isolated metastasis of the initial endometrial carcinoma was observed in the vulva and required surgical excision. Two and a half years later, the patient remains disease-free. Eleven articles consisting of 22 cases of metastatic endometrial carcinoma to the vulva have been reported in the English literature. To our knowledge, this is only the second case of developing isolated vulvar metastasis after minimal invasive surgery for low risk gynecological cancer described in literature. Conclusion: The hereby presented case report aims to raise awareness, among surgeons, regarding lesions that can be developed in the vulva after minimally invasive surgery of even low-risk, well differentiated EAC, which may represent recurrence of the primary cancer.