LAPAROSCOPIC REMOVAL OF GONADS CONTAINING AN OCCULT SEMINOMA IN A WOMAN WITH COMPLETE ANDROGEN RESISTANCE

A 20-year-old woman with complete androgen resistance (AR; 46,XY), und erwent prophylactic laparoscopic gonadectomy because of the known incr eased risk of gonadal malignancy. The procedure was performed with ele ctrocoagulation using a four-puncture technique. Pelvic and abdominal inspection revealed no gonadal or metastatic tumor. The testes and att ached structures were retracted medially, and the peritoneum and gonad al vessels were incised after electrocoagulation, thereby removing the gonads from the sidewalls. The gonads were individually placed into a specimen retrieval bag and removed through the suprapubic cannula sit e. Pathologic examination revealed an occult 8-mm seminoma in the left gonad, as well as bilateral Sertoli cell hamartomas, fallopian tube r emnants, and smooth muscle tissue (mullerian remnants) adjacent to the gonads. Postoperatively, tumor markers were normal, and abdominal and pelvic computerized tomographic scans and chest radiographs were nega tive for possible metastatic disease. This case confirms that laparosc opic removal of testes in women with AR is effective, safe, and quick. Because a normal-appearing gonad may contain an occult tumor, we reco mmend using a retrieval bag, which may prevent dissemination of potent ially malignant cells that may occur with unprotected morcellation.