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Liu D, Wei H, Huang J, Shen H, Wang X, Hu C. Clear Cell Adenocarcinoma Arising from Endometriosis in Abdominal Wall Cesarean Section Scar: A Case Report and Literature Review. Int J Womens Health 2023; 15:25-32. [PMID: 36636515 PMCID: PMC9830077 DOI: 10.2147/ijwh.s382235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/17/2022] [Indexed: 01/06/2023] Open
Abstract
Background Endometriosis developing in a cesarean section (CS) scar is an unusual event. Malignant transformation arising on the background of scar endometriosis in the abdominal wall is extremely rare. Herein we report a case of clear cell carcinoma (CCC) arising in the abdominal wall from endometriosis tissues following CS and review previous literature. Case Presentation A 48-year-old gravida 2 para 1 female presented with an abdominal wall mass at her CS scar, which increased in size and became painful in the last 2 years. Physical examination showed a multilocular solid mass of about 13 cm, at the previous CS scar. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 12.8cm × 7.7cm multi-septate cystic lesion on the anterior abdominal wall, and histological examination showed that CCC was caused by the transformation of abdominal wall endometriosis (AWE). Conclusion An endometriosis-associated malignancy should be considered in the differential with any enlarging mass in the abdominal wall scar.
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Affiliation(s)
- Dong Liu
- Radiological Department, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Huanhuan Wei
- Academy of Medical Sciences, the People’s Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Jinyu Huang
- Radiological Department, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Hailin Shen
- Department of Radiology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, People’s Republic of China
| | - Ximing Wang
- Radiological Department, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Chunhong Hu
- Radiological Department, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
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Clear cell carcinoma of the abdominal wall: A case report with a review of the literature. Ann Med Surg (Lond) 2022; 79:104038. [PMID: 35860058 PMCID: PMC9289458 DOI: 10.1016/j.amsu.2022.104038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction and importance Clear cell carcinoma of abdominal wall is a very rare and aggressive disease. It is mostly related to malignant transformation of abdominal wall endometriosis. This paper provides a new case report and a literature review of primitive abdominal wall clear cell carcinoma. Case presentation A 45-year-old woman with a history of a two previous caesarian section presented to the outpatient department with a tumor mass evolving since 10 years in the lower right quadrant of her abdomen. Imaging studies revealed a voluminous subcutaneous mass developing at the expense of the anterior abdominal wall. Surgical resection of the mass was performed. Histopathological examination along with immunohistochemical analysis were consistent with clear cell carcinoma. Biopsies of the endometrium and ovaries were performed and were negative for malignancy. The patient underwent therefore a hysterectomy with bilateral salpingo-oophorectomy which did not reveal any disease. The diagnosis of primitive clear cell carcinoma of the abdominal wall was then confirmed. Clinical discussion Primitive clear cell carcinoma of the abdominal wall is an extremely rare form of cancer with usually poor prognosis. Clinicians must be aware of the possibility of malignancy of any swelling mass occurring near or within a caesarean section scar. Conclusion Reporting more such cases is still needed to further progress in the understanding of this malignancy in addition to the development of treatment strategies. Clear cell carcinoma (CCC) occurring in the anterior abdominal wall is an extremely rare but aggressive tumor. It is usually secondary to malignant transformation of abdominal wall scar endometriosis. Caesarean section is the major factor of developing abdominal wall scar endometriosis. Treatment is mainly based on extensive surgery with free margins.
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Giannella L, Marconi C, Di Giuseppe J, Delli Carpini G, Fichera M, Grelloni C, Giuliani L, Montanari M, Insinga S, Ciavattini A. Malignant Transformation of Postmenopausal Endometriosis: A Systematic Review of the Literature. Cancers (Basel) 2021; 13:4026. [PMID: 34439184 PMCID: PMC8394809 DOI: 10.3390/cancers13164026] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: This study aimed to systematically review the existing literature on malignant transformation of postmenopausal endometriosis to provide information about patient characteristics, hormonal replacement therapy (HRT) use, and outcomes over a period of 52 years (1969-2021). Methods: According to PRISMA guidelines, we searched for (endometriosis OR endometriotic) AND (cancer OR malignancy OR malignant transformation) AND (menopause OR menopausal OR postmenopause OR postmenopausal) in Pubmed (all fields) (accessed on 12 February 2021) and Scopus (Title/Abstract/Keywords) (accessed on 12 February 2021) databases. The only filter used was the English language. Relevant articles were obtained in full-text format and screened for additional references. Eligibility/inclusion criteria: studies including full case description of malignant transformation of endometriosis-related lesions in postmenopause. Results: 75 studies, including 90 cases, were retrieved. The mean age was 55.8 ± 8.5 years. Overall, about 65% of women had a positive personal history of endometriosis/adenomyosis, and 64% of women underwent previous hysterectomy ± bilateral salpingo-oophorectomy. Forty-nine of 74 women used HRT (66.2%). Among the women who used HRT, estrogen-only treatment was taken by approximately 75%. Duration of HRT was longer than five years in 63.3% of cases. About 70% of subjects had histology of endometrioid adenocarcinoma or clear cell carcinoma. Follow-up outcome, available for 61 women, showed a survival rate of 78.7%, recurrence of 9.8%, death of 11.5%. The duration of follow-up had a median of 12 months (interquartile range, 6.75-25 months). Interestingly, over the years of case publication there was a significant inverse correlation with previous history of endometriosis (r = -0.28, p = 0.007), HRT use (r = -0.31, p = 0.006), and previous definitive surgery (r = -0.42, p < 0.001). Conclusions: In the malignant transformation of postmenopausal endometriosis, there are some recurrent clinical conditions: previous endometriosis, major definitive surgery before menopause, and estrogen-only HRT for a relatively long time. However, these clinical conditions have shown a drastic decrease over time. This could likely be the consequence of different attitudes and management of gynecologists linked to up-to-date scientific evidence about the use of major surgery in gynecological pathologies. Malignant transformation of postmenopausal endometriosis is a clinical challenge to be explored further.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Andrea Ciavattini
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Via Filippo Corridoni, 16, 60123 Ancona, Italy; (L.G.); (C.M.); (J.D.G.); (G.D.C.); (M.F.); (C.G.); (L.G.); (M.M.); (S.I.)
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4
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Liu G, Wang Y, Chen Y, Ren F. Malignant transformation of abdominal wall endometriosis: A systematic review of the epidemiology, diagnosis, treatment, and outcomes. Eur J Obstet Gynecol Reprod Biol 2021; 264:363-367. [PMID: 34391052 DOI: 10.1016/j.ejogrb.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/23/2021] [Accepted: 08/04/2021] [Indexed: 02/07/2023]
Abstract
Malignant transformation of abdominal wall endometriosis (AWE) is rare. The clinical characteristics and treatment of malignant transformation of AWE are not well known. Therefore, in this review, we performed a thorough search for malignant transformation of AWE on MEDLINE and Web of Science from their inception to May 2021. In total, the data of 46 patients with malignant transformation of AWE were retrieved, and all the data on these patients were collected. After reviewing and analyzing the clinical parameters, we found that cesarean scar was the most common site of malignant transformation of AWE, and the most common pathological type of malignant transformation of AWE was clear cell cancer, followed by endometrioid adenocarcinoma. The main symptoms of malignant transformation of AWE included an abdominal nodule or mass, and ultrasonography was the first choice for diagnosis. The most widely accepted treatment was surgical resection of local lesions with adjunctive chemotherapy and/or radiotherapy, and the overall survival of patients with malignant transformation of AWE was poor. In conclusion, malignant transformation of AWE is rare, and the prognosis is poor. Thus, improving abdominal surgical technology and avoiding iatrogenic ectopia and implantation of the endometrium are necessary to prevent malignant transformation of AWE.
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Affiliation(s)
- Gang Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Yizi Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Yinghan Chen
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Fang Ren
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China.
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5
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Giannella L, Serri M, Maccaroni E, DI Giuseppe J, Carpini GD, Berardi R, Sopracordevole F, Ciavattini A. Endometriosis-associated Clear Cell Carcinoma of the Abdominal Wall After Caesarean Section: A Case Report and Review of the Literature. In Vivo 2021; 34:2147-2152. [PMID: 32606196 DOI: 10.21873/invivo.12021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM Clear cell carcinoma of the abdominal wall is a sporadic event. To date, about thirty cases have been reported in the literature. This article provides a case report and literature review of an infrequent occurrence with poor prognosis. CASE REPORT A 45-year-old woman with pelvic pain and an abdominal mass came to our attention. Her medical history was notable for two previous cesarean sections. Physical examination revealed a smooth, multilocular mass measuring about 20 cm, arising from the previous surgical scar. Histology revealed clear-cell carcinoma resulting from the transformation of abdominal wall endometriosis. Given the disease extent, the patient underwent front-line chemotherapy. After several and multiple chemotherapy regimens, there was a disease progression that resulted in the death of the patient in 7 months. The literature review showed that a previous cesarean section was present in 91% of cases. Besides, approximately 26.5% of women died within 12 months of being diagnosed. The mean age of women was 45.88 years, while the average size of the lesion was 11 cm. CONCLUSION Clear cell carcinoma is a rare but occurring event. Middle-aged women showing an abdominal wall mass in close relation with a surgical scar from a previous cesarean section must be promptly investigated. Treatment options usually include surgery and chemotherapy with poor results.
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Affiliation(s)
- Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Matteo Serri
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Elena Maccaroni
- Medical Oncology Unit, Polytechnic University of Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Jacopo DI Giuseppe
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Rossana Berardi
- Medical Oncology Unit, Polytechnic University of Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, CRO Centro di Riferimento Oncologico National Cancer Institute, Aviano, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
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6
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Ferrari F, Valenti G, Forte S, Ardighieri L, Iraci Sareri M, Barra F, Sartori E, Odicino F. Clear cell degeneration associated with endometriosis of abdominal wall after cesarean section: A case report and systematic review of literature. J Obstet Gynaecol Res 2021; 47:1243-1252. [PMID: 33442929 DOI: 10.1111/jog.14635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/11/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
AIM The scar of cesarean section (CS) is the most common site of abdominal wall endometriosis (AWE), whose tumor degeneration has been reported in an increasing number of cases; the most frequent histological type is clear cell carcinoma (CCC). METHODS We conducted a systematic research of the literature, collecting data regarding the evidence on tumor degeneration from AWE after CS. Moreover, we reported a case of clear cell borderline tumor (CCBT) originating from AWE. RESULTS We included data of 37 patients with diagnosis of CCC. The average time between the last CS and the diagnosis of CCC was around 15 years. Overall, 26.0% and 73.9% patients received exclusive local abdominal resection of the lesion and additional surgery, respectively. Lymph nodes involvement was detected in 26.0 % patients and adjuvant chemotherapy was administered in 52.0 % cases. During follow-up period, 15.2% patients died of disease, 32.6% had no evidence of disease, and 17.4% recurred. We diagnosed a CCBT arose in a patients with AWE and a personal history of several surgical procedures for endometriosis, a CS and a subsequent transverse laparotomy. We performed an open bilateral ovariectomy and a large excision of the endometriotic abdominal lesion. CONCLUSION Tumor degeneration from AWE seems to be a real occurrence with an increasing number of events. Considering the lack of risk factors and diagnostic instruments for tumor degeneration, the removal of AWE localization could be advisable, even though there was long average time between the trigger surgery and the tumor finding.
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Affiliation(s)
- Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili of Brescia, Brescia, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Gynecology, University of Catania, Catania, Italy
| | - Sara Forte
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Laura Ardighieri
- Department of Pathology, Spedali Civili of Brescia, Brescia, Italy
| | - Marco Iraci Sareri
- Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Gynecology, University of Catania, Catania, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Enrico Sartori
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Franco Odicino
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
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7
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Bedell S, Chang Z, Burt C, Khalifa MA, Argenta PA. Incisional carcinoma of Mullerian Origin: A case report and review of literature. Gynecol Oncol Rep 2020; 33:100588. [PMID: 32490125 PMCID: PMC7262414 DOI: 10.1016/j.gore.2020.100588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/18/2020] [Indexed: 11/29/2022] Open
Abstract
Incisional carcinoma is a rare, often delayed, complication of surgery. Primary incisional carcinoma can occur in the presence or absence of endometriosis. Translocation of benign cells surgery may be a common mode of development.
Primary incisional carcinoma (PIC) is a rare, delayed complication of surgery, usually attributed to the malignant transformation of endometriosis. We report a case of incisional carcinoma with nodal metastases in a 55-year-old woman, 18 years after cesarean section. She underwent extirpative surgery, including hysterectomy and bilateral salpingo-oophorectomy, without intraperitoneal disease identifed. Adjuvant treatment included sandwiched platinum-based chemotherapy (carboplatin and paclitaxel) and radiation. She remains disease-free 8 months after completing therapy. We identified 46 additional reported cases. Of these, >90% had undergone an “endometrium-exposing” surgery, most commonly cesarean section; while no cases followed adnexal-only surgery. The median time between antecedent surgery and presentation was 18 years. At presentation, tumors were often large (median 8 cm), and symptomatic with pain (63%) and/or mass (26%). Serum CA125 levels were commonly, albeit slightly, elevated (median 57U/ml (IQR 22–96, Range 6–1690)). Lymph node metastases were common (35%), with most following a vulvar-type spread pattern (inguinal first). Most patients (63%) were treated with chemotherapy +/− radiation. Approximately 50% of patients recurred promptly (median < 6 months), but long-term survival was reported following combined chemotherapy/radiation. Lymph node metastases portended a shorter disease-free interval, with 73% of cases recurring (median 5 months) despite chemotherapy-based treatment. These data suggest that some incisional carcinomas may result from displacement of healthy endometrium followed by delayed malignant transformation. Chemotherapy-only and radiation-only treatments are attended by modest prognosis. Taken together, these data suggest there is both need and potential avenues for improved prevention, detection, and treatment of this condition.
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Affiliation(s)
- Sabrina Bedell
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, MN, United States
| | - Zenas Chang
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, MN, United States
| | - Cassaundra Burt
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, MN, United States
| | - Mahmoud A Khalifa
- Department of Pathology and Laboratory Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Peter A Argenta
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, MN, United States
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8
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Abdominal Wall Clear Cell Carcinoma: Case Report of a Rare Event with Potential Diagnostic Difficulties. Case Rep Pathol 2019; 2019:1695734. [PMID: 31396428 PMCID: PMC6668542 DOI: 10.1155/2019/1695734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/07/2019] [Indexed: 12/14/2022] Open
Abstract
Clear cell carcinoma (CCC) is a well-known aggressive histological type of carcinoma, predominantly seen in ovary and endometrium. However, CCC arising in abdominal wall is a very rare event. We report a case of a 48-year-old woman with an abdominal wall mass at her cesarean section (c-section) scar, which increased in size and became painful in the last months. Radiology revealed a 7 cm mass in the right inferior rectus muscle sheath, suggestive of endometriosis. An irregular, firm mass was resected, densely adherent to the rectus muscle and pubic bone. Frozen section revealed a multicystic lesion with minimal cytologic atypia, and a benign cystic neoplasm was favored. However, permanent sections showed marked nuclear atypia, hobnail morphology, and areas of infiltrative growth within fibrous stroma. No benign endometrial glands were found, although fibrosis and hemorrhage were present. Napsin-A, racemase, and PAX-8 were positive, consistent with CCC, likely arising within a c-section endometriosis focus. Although CCC usually presents with moderate to marked nuclear atypia, it can be mild and, especially in cases with a predominant cystic pattern, create diagnostic difficulties. An endometriosis-associated malignancy should be considered in the differential with any enlarging nodule or increasing pain within an abdominal wall scar.
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9
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Abaid LN, Cupp JS, Chang M, Beanes SR, Goldstein BH. Clear cell carcinoma of the pelvic side wall arising from endometriosis. Gynecol Oncol Rep 2018; 25:24-26. [PMID: 30073183 PMCID: PMC6069576 DOI: 10.1016/j.gore.2018.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 12/26/2022] Open
Abstract
Endometriosis is a condition wherein an ectopic layer of endometrial tissue arises in an extra-uterine location, often effecting significant pelvic pain and infertility. While very uncommon, there have been reported cases of endometriosis undergoing malignant transformation, frequently involving the ovaries and seldom in extra-gonadal regions. We recount a case depicting a 63 year-old woman who presented with an apparent inguinal hernia in 2017; she was ultimately diagnosed with a pelvic side wall clear cell carcinoma and attendant metastatic disease to the medial groin, which emanated from endometriosis. Malignant transformation of endometriosis identified in the pelvic side wall is a very rare finding. Nevertheless, oncologists should maintain a high index of suspicion in patients with a history of endometriosis or pelvic surgery.
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Affiliation(s)
- Lisa N Abaid
- Gynecologic Oncology Associates, Hoag Memorial Hospital, Newport Beach, CA 926631, United States
| | - John S Cupp
- Department of Pathology, Hoag Memorial Hospital, Newport Beach, CA, United States
| | - Miles Chang
- Department of Radiology, Hoag Memorial Hospital, Newport Beach, CA, United States
| | - Steven R Beanes
- Department of General Surgery, Newport Beach, CA, United States
| | - Bram H Goldstein
- Gynecologic Oncology Associates, Hoag Memorial Hospital, Newport Beach, CA 926631, United States
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10
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Vitral GSF, Salgado HC, Rangel JMDC. Use of radioguided surgery in abdominal wall endometriosis: An innovative approach. World J Nucl Med 2018; 17:204-206. [PMID: 30034288 PMCID: PMC6034545 DOI: 10.4103/wjnm.wjnm_47_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Endometriosis is characterized by the presence of endometrial glands and stroma outside the uterine cavity. The occurrence of endometriosis in the anterior abdominal wall is often associated with previous cesarean section, once the spread of endometrial cells during the surgical procedure is a biologically fact possible. A 43-year-old patient, with cesarean section history and pelvic endometriosis diagnosed for over 10 years, presented with progressive abdominal pain. Tests showed cystic image with 1.6 cm of diameter and debris, located in mid-lower portion of the rectus abdominis left, suggesting abdominal wall endometriosis. This abdominal wall lesion was not identifiable in the clinical examination (impalpable), which is why we opted for the use of preoperative marking technique with radioisotope called Radioguided Occult Lesion Localization (ROLL™). The use of ROLL™ in this case allowed rapid surgical identification of endometriotic lesion and its complete excision.
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Affiliation(s)
- Geraldo Sérgio Farinazzo Vitral
- Department of Surgery, Woman Health Investigation Group, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Hakayna Calegaro Salgado
- Department of Surgery, Woman Health Investigation Group, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - João Matheus de Castro Rangel
- Department of Surgery, Woman Health Investigation Group, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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11
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Ji W, Wu J, Cheng J, Di W. Serous adenocarcinoma arising from endometriosis in cesarean section abdominal wall scar: a case report and literature review. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:7534-7541. [PMID: 31966597 PMCID: PMC6965303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/05/2017] [Indexed: 06/10/2023]
Abstract
BACKGROUND Abdominal wall endometriosis has been well-described and can occur after caesarean section. However, malignant transformation of abdominal wall endometriosis is rare, less than 40 cases have been reported so far and its pathogenesis is still poorly understood. CASE REPORT Here, we report a 48-year-old woman, gravida 1, para 1, with a history of uneventful caesarean delivery presented with increasing pain and a rapid growing mass in her cesarean section scar. Serum tumor markers, especially CA125 and CA199 increased remarkably. Physical examination and pelvic magnetic resonance imaging showed a mass sized 15 cm in maximum diameter and the enlarged pelvic lymph nodes. Neoadjuvant chemotherapy and surgery were performed, followed by chemotherapy. The surgery contained radical resection, excision of bilateral accessory, hysterectomy, omentectomy, lymph node excision and abdominal dermoplasty. Histopathological examination showed a serous adenocarcinoma of endometrial origin with lymph node metastasis. Recurrence was noted 3 months after surgery and the patient was followed up until now. 33 literatures on similar cases were reviewed. CONCLUSION Extensive lymph nodes metastasis might predict a poor prognosis in case of malignant transformation of abdominal wall endometriosis. Radical resection followed by chemotherapy is the most common treatment. Once recurrence occurs, treatments including chemotherapy and radiotherapy are usually ineffective.
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Affiliation(s)
- Wenting Ji
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200127, China
- Shanghai Key Laboratory of Gynecologic OncologyChina
| | - Jiayue Wu
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200127, China
- Shanghai Key Laboratory of Gynecologic OncologyChina
| | - Jiejun Cheng
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200127, China
| | - Wen Di
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200127, China
- Shanghai Key Laboratory of Gynecologic OncologyChina
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12
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Ferrandina G, Palluzzi E, Fanfani F, Gentileschi S, Valentini AL, Mattoli MV, Pennacchia I, Scambia G, Zannoni G. Endometriosis-associated clear cell carcinoma arising in caesarean section scar: a case report and review of the literature. World J Surg Oncol 2016; 14:300. [PMID: 27912770 PMCID: PMC5135835 DOI: 10.1186/s12957-016-1054-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/22/2016] [Indexed: 12/03/2022] Open
Abstract
Background Malignant transformation has been reported in approximately 1% of the endometriosis cases; herein, we report a case of clear cell endometrial carcinoma arising from endometriosis foci located within a caesarean section scar. Case presentation In November 2014, a Caucasian, 44-year-old woman was transferred to our institution because of severe respiratory failure due to massive lung embolism and rapid enlargement of a subcutaneous suprapubic mass. Abdomino-pelvic magnetic resonance showed a 10.5 × 5.0 × 5.0 cm subcutaneous solid mass involving the rectus abdominis muscle. Pelvic organs appeared normal, while right external iliac lymph nodes appeared enlarged (maximum diameter = 16 mm). A whole-body positron emission tomography/computed tomography scan showed irregular uptake of the radiotracer in the 22 cm mass of the abdominal wall, and in enlarged external iliac and inguinal lymph nodes. In December 2014, the patient underwent exploratory laparoscopy showing normal adnexae and pelvic organs; peritoneal as well as cervical, endometrial and vesical biopsies were negative. The patient was administered neo-adjuvant chemotherapy with carboplatin and paclitaxel, weekly, without benefit and then underwent wide resection of the abdominal mass, partial removal of rectus abdominis muscle and fascia, radical hysterectomy, bilateral salpingo-oophorectomy, and inguinal and pelvic lymphadenectomy. The muscular gap was repaired employing a gore-tex mesh while the external covering was made by a pedicled perforator fasciocutaneous anterolateral thigh flap. Final diagnosis was clear cell endometrial adenocarcinoma arising from endometriosis foci within the caesarean section scar. Pelvic and inguinal lymph nodes were metastatic. Tumor cells were positive for CK7 EMA, CKAE1/AE3, CD15, CA-125, while immunoreaction for Calretinin, WT1, estrogen, and progesterone receptors, cytokeratin 20, CD10, alpha fetoprotein, CDX2, TTF1, and thyroglobulin were all negative. Liver relapse occurred after 2 months; despite 3 cycles of pegylated liposomal doxorubicin (20 mg/m2, biweekly administration), the death of the patient disease occurred 1 month later. Conclusions Attention should be focused on careful evaluation of patient history in terms of pelvic surgery, and symptoms suggestive of endometriosis such as repeated occurrence of endometriosis nodules at CS scar, or cyclic pain, or volume changes of the nodules.
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Affiliation(s)
- Gabriella Ferrandina
- Department Medicine and Health Sciences, University of Molise, Campobasso/Gynecologic Oncology Unit, Campobasso, Italy. .,Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.
| | - Eleonora Palluzzi
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - Francesco Fanfani
- Department Medicine and Aging Sciences, University "G D'Annunzio", Chieti-Pescara, Italy
| | - Stefano Gentileschi
- Department Plastic and Reconstructive Surgery, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - Anna Lia Valentini
- Department Radiological Sciences, Institute of Radiology, Catholic University, Rome, Italy
| | - Maria Vittoria Mattoli
- Institute of Nuclear Medicine, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | | | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
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13
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Transformation of Abdominal Wall Endometriosis to Clear Cell Carcinoma. Case Rep Obstet Gynecol 2015; 2015:123740. [PMID: 26457213 PMCID: PMC4589608 DOI: 10.1155/2015/123740] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/22/2015] [Accepted: 09/07/2015] [Indexed: 11/20/2022] Open
Abstract
Clear cell carcinoma is the least common of the malignant transformations reported in nonpelvic sites of endometriosis. Two cases with clear cell carcinoma transformation arising from endometriosis in abdominal wall scars are presented. These patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic washings, and abdominal wall lesion resection. The first case had initial treatment with chemotherapy, while chemotherapy and radiation therapy were given for the second case. A recurrence was noted for the chemotherapy only case for, which she was subsequently given radiation, with further resolution of the lesion.
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14
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Tarumi Y, Mori T, Kusuki I, Ito F, Kitawaki J. Endometrioid adenocarcinoma arising from deep infiltrating endometriosis involving the bladder: A case report and review of the literature. Gynecol Oncol Rep 2015; 13:68-70. [PMID: 26425727 PMCID: PMC4563797 DOI: 10.1016/j.gore.2015.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/06/2015] [Accepted: 07/12/2015] [Indexed: 11/16/2022] Open
Abstract
Malignant transformation of deep infiltrating endometriosis involving the bladder is quite rare. We review eight relevant cases which have been reported. This is the second case fulfilling Sampson and Scott criteria.
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Affiliation(s)
- Yosuke Tarumi
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan ; Department of Obstetrics and Gynecology, Nantan General Hospital, 25 Yagiueno, Yagi-cho, Nanntann-shi, Kyoto 629-0197, Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Nantan General Hospital, 25 Yagiueno, Yagi-cho, Nanntann-shi, Kyoto 629-0197, Japan
| | - Izumi Kusuki
- Department of Obstetrics and Gynecology, Nantan General Hospital, 25 Yagiueno, Yagi-cho, Nanntann-shi, Kyoto 629-0197, Japan
| | - Fumitake Ito
- Department of Obstetrics and Gynecology, Nantan General Hospital, 25 Yagiueno, Yagi-cho, Nanntann-shi, Kyoto 629-0197, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Nantan General Hospital, 25 Yagiueno, Yagi-cho, Nanntann-shi, Kyoto 629-0197, Japan
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