Up to 1% of women with endometriosis develop endometriosis-associated neoplasms [1]. Most endometriosis-associated malignant tumors develop from the ovarian endometriomas, whereas those developing from extragonadal lesions are extremely rare, estimated at 0.2% [2]. Because they are uncommon, a treatment protocol for the malignant transformation of extragonadal endometriosis lesions has not been clearly defined. When the lesion is confined to the site of origin and R0 resection is achieved, the 5-year survival rate is between 82% and 100%; therefore, complete resection should be performed [3]. The patient in this video had previously undergone hysterectomy, bilateral salpingo-oophorectomy, left nephrectomy, and low-anterior resection of the rectum due to severe endometriosis. Ten years after the surgery, the patient had a 6 cm endometrioid adenocarcinoma developing from the residual endometriosis lesion at the left uterosacral ligament that involved the bladder, left ureter, and rectum. In this case, the tumor was attached to the pelvis due to infiltration of the left sacrospinous ligament. To completely remove the tumor, we used laterally extended endopelvic resection with abdominoperineal resection of the rectum. We used the laparoscopic-perineal-laparoscopic approach (pincer approach) because improved visualization of the left sacrospinous ligament increases the probability of achieving complete resection [4]. Pathological R0 resection was achieved without intraoperative or postoperative complications. Thus, for tumors that are firmly attached to the pelvic floor, the pincer approach can be useful for achieving R0 resection. The informed consent for use of this video was taken from the patient.

Objectives  To describe the current situation regarding the medical information provided for foreign residents by the official websites of cities and municipalities in Aichi Prefecture and to investigate associations between the characteristics of each city/municipality and their provision of online medical informationMethods  Using a checklist of 24 items, the official websites of all 54 cities and municipalities (hereafter local governments) in Aichi Prefecture were checked. Each item was descriptively summarized. Associations between three selected items and local government characteristics were analyzed by Fisher’s exact test.Results  The official websites of 49 local governments (90.7%) were translated into at least one foreign language. An automatic translation system was used by 43 websites (79.6%). Information on emergency medicine was translated into at least one foreign language on 45 websites (83.3%), child health checkups on 44 websites (81.5%), and adult health checkups on 42 websites (77.8%). However, only eight local governments (14.8%) provided information on where child health checkups were available, and 23 (42.6%) translated a list of medical facilities where adult health checkups were available. The provision of a link to the Aichi Medical Information System was significantly associated with the size of the local government and the number of foreigners. Ten (76.9%) out of 13 local governments categorized in the highest quartile for proportion of foreigners had not translated the list of medical facilities for adult health checkup.Conclusion  Many local governments rely on the automatic translation system, which does not have the capacity to manage all the information accurately. Compared to information on emergency care, access to information on child health checkups and adult health checkups, which will be increasingly needed in the future, was poor and limited. An external website for shared use was not fully utilized, in particular, by smaller local governments.