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Alaert J, Lancelle M, Timmermans M, Tanos P, Nisolle M, Karampelas S. Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review. J Clin Med 2024; 13:2282. [PMID: 38673556 PMCID: PMC11050881 DOI: 10.3390/jcm13082282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Malignant-associated abdominal wall endometriosis (AWE) is a rare pathology, likely to occur in 1% of scar endometriosis. The objectives of this study were to update the evidence on tumor degeneration arising from AWE to notify about the clinical characteristics, the different treatments offered to patients and their outcomes. Methods: A comprehensive systematic review of the literature was conducted. PubMed, Embase and Cochrane Library databases were used. Prospero (ID number: CRD42024505274). Results: Out of the 152 studies identified, 63 were included, which involved 73 patients. The main signs and symptoms were a palpable abdominal mass (85.2%) and cyclic pelvic pain (60.6%). The size of the mass varied between 3 and 25 cm. Mean time interval from the first operation to onset of malignant transformation was 20 years. Most common cancerous histological types were clear cell and endometrioid subtypes. Most widely accepted treatment is the surgical resection of local lesions with wide margins combined with adjuvant chemotherapy. The prognosis for endometriosis-associated malignancy in abdominal wall scars is poor, with a five-year survival rate of around 40%. High rates of relapse have been reported. Conclusions: Endometrial implants in the abdominal wall should be considered as preventable complications of gynecological surgeries. Special attention should be paid to women with a history of cesarean section or uterine surgery.
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Affiliation(s)
- Julie Alaert
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium; (J.A.); (S.K.)
| | - Mathilde Lancelle
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Tivoli, Université Libre de Bruxelles, 7100 La Louviere, Belgium;
| | - Marie Timmermans
- Department of Obstetrics and Gynecology, CHU of Liege—Citadelle Site, University of Liège, 4000 Liege, Belgium; (M.T.); (M.N.)
| | - Panayiotis Tanos
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium; (J.A.); (S.K.)
| | - Michelle Nisolle
- Department of Obstetrics and Gynecology, CHU of Liege—Citadelle Site, University of Liège, 4000 Liege, Belgium; (M.T.); (M.N.)
| | - Stavros Karampelas
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium; (J.A.); (S.K.)
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2
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Szubert M, Nowak-Glück A, Domańska-Senderowska D, Szymańska B, Sowa P, Rycerz A, Wilczyński JR. miRNA Expression Profiles in Ovarian Endometriosis and Two Types of Ovarian Cancer-Endometriosis-Associated Ovarian Cancer and High-Grade Ovarian Cancer. Int J Mol Sci 2023; 24:17470. [PMID: 38139300 PMCID: PMC10743418 DOI: 10.3390/ijms242417470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Endometriosis-associated ovarian cancer (EOC) consisting of endometrioid cancer and clear-cell ovarian cancer could be promoted by many factors. miRNAs, which are small, non-coding molecules of RNA, are among them. The aim of this study was to detect miRNAs connected with the malignant transformation of endometriosis. FFPE (formalin-fixed, paraffin-embedded) samples of 135 patients operated on for endometriosis and different types of ovarian cancer (EOC and HGSOC-high-grade serous ovarian cancer) were studied. Healthy ovarian tissue was used as a control group. From the expression panel of 754 miRNAs, 7 were chosen for further tests according to their ROC (receiver operating characteristic) curves: miR-1-3p, miR-125b-1-3p, miR-31-3p, miR-200b-3p, miR-502-5p, miR-503-5p and miR-548d-5p. Furthermore, other potentially important clinical data were analysed, which included age, BMI, Ca-125 concentration, miscarriages and deliveries and concomitant diseases such as hypertension, type 2 diabetes and smoking. Among the miRNAs, miR200b-3p had the lowest expression in neoplastic tissues. miR31-3p had the highest expression in women without any lesions in the ovaries. miR-502-5p and miR-548-5p did not differ between the studied groups. The examined miRNA panel generally distinguished significantly normal ovarian tissue and endometriosis, normal ovarian tissue and cancer, and endometriosis and cancer. The malignant transformation of endometriosis is dependent on different factors. miRNA changes are among them. The studied miRNA panel described well the differences between endometriosis and EOC but had no potential to differentiate types of ovarian cancer according to their origin. Therefore, examination of a broader miRNA panel is needed and might prove itself advantageous in clinical practice.
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Affiliation(s)
- Maria Szubert
- Department of Surgical and Oncologic Gynaecology, 1st Department of Gynaecology and Obstetrics, M. Pirogow’s Teaching Hospital, Medical University of Lodz, Wilenska 37 St., 94-029 Lodz, Poland; (A.N.-G.); (A.R.); (J.R.W.)
- Club 35. Polish Society of Gynaecologists and Obstetricians, ul. Cybernetyki 7F/87, 02-677 Warsaw, Poland
| | - Anna Nowak-Glück
- Department of Surgical and Oncologic Gynaecology, 1st Department of Gynaecology and Obstetrics, M. Pirogow’s Teaching Hospital, Medical University of Lodz, Wilenska 37 St., 94-029 Lodz, Poland; (A.N.-G.); (A.R.); (J.R.W.)
| | | | - Bożena Szymańska
- Research Laboratory CoreLab, Medical University of Lodz, Mazowiecka 6/8 St., 92-215 Lodz, Poland;
| | - Piotr Sowa
- Department of Pathology, M. Pirogow’s Teaching Hospital, Wilenska 37 St., 94-029 Lodz, Poland;
| | - Aleksander Rycerz
- Department of Surgical and Oncologic Gynaecology, 1st Department of Gynaecology and Obstetrics, M. Pirogow’s Teaching Hospital, Medical University of Lodz, Wilenska 37 St., 94-029 Lodz, Poland; (A.N.-G.); (A.R.); (J.R.W.)
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Mazowiecka 15 St., 92-215 Lodz, Poland
| | - Jacek R. Wilczyński
- Department of Surgical and Oncologic Gynaecology, 1st Department of Gynaecology and Obstetrics, M. Pirogow’s Teaching Hospital, Medical University of Lodz, Wilenska 37 St., 94-029 Lodz, Poland; (A.N.-G.); (A.R.); (J.R.W.)
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3
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Kim JM, Hong DG. Is ovarian cystectomy for atypical ovarian endometrioma safe?: A single center study. Medicine (Baltimore) 2022; 101:e30105. [PMID: 36107548 PMCID: PMC9439743 DOI: 10.1097/md.0000000000030272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Ovarian atypical endometriosis (AE) is a premalignant lesion, and its potential to progress to endometriosis-associated ovarian cancer emphasizes its significance. However, the true risk of malignancy in AE remains unclear. Therefore, this study aimed to investigate the clinical outcomes of ovarian AE after ovarian cystectomy. We retrospectively reviewed the medical records and histopathological reports of 41 patients who had been diagnosed with ovarian AE between January 2011 and April 2020. We reviewed age, obstetric history, age at menarche, preoperative CA 125 level, C-reactive protein level, erythrocyte sedimentation rate, endometriosis stage, mean follow-up duration, postoperative hormonal therapy, and prognosis, including recurrence of endometriosis and malignant transformation. Among 41 patients with pathologically diagnosed ovarian AE, 26 were followed up after cystectomy only. The average follow-up period was 58.27 ± 33.22 months in cystectomy only patients. The mean age of the patients with cystectomy only versus that of patients with endometriosis-associated ovarian carcinoma was 32.73 ± 6.10 versus 48.29 ± 4.35 (P < .01) years. The preoperative CA 125 level was 115.63 ± 219.06 versus 225.75 ± 163.39 (P < .051) U/mL. Patients with endometriosis-associated ovarian carcinoma or other diseases and those who underwent oophorectomy were excluded. After surgery, hormone therapy was administered to 22 of 26 patients, and the remaining 4 patients were followed up without additional treatment. Endometriosis recurrence occurred in 5 patients, 1 of whom underwent second-line laparoscopic ovarian cystectomy. However, no malignant transformations were observed. Ovarian AE has a low possibility of malignant transformation. Conservative treatment is recommended after appropriate ovarian cystectomy, such as enucleation.
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Affiliation(s)
- Jong Mi Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
- *Correspondence: Dae Gy Hong, Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu 41404, Republic of Korea (e-mail: )
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4
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Yao R, Wu P, Sung CJ, Lamson JA, Zhang C. Malignant Mixed Mullerian Tumor Arising from Endometriosis in the Groin: A Case Report and Literature Review. Int J Surg Pathol 2022; 31:338-342. [PMID: 35708000 DOI: 10.1177/10668969221105618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This was a 57-year-old woman who presented with mild discomfort in the right groin. Physical examination revealed a mass in the right groin, and by ultrasound, the mass was hypoechoic and solid with some internal vascularity. The clinical differential diagnosis included lymphoma and others. The mass was excised for pathologic evaluation. Gross examination of the specimen revealed a 3 × 2.4 × 2 cm, solid and cystic mass. Microscopically, it was a biphasic tumor consisting of carcinomatous and sarcomatous components. The tumor was seen contiguous with endometriosis and atypical endometrioid hyperplasia. The histologic findings were consistent with malignant mixed Mullerian tumor (MMMT) arising from endometriosis in the right groin. The tumor involved the resection margin. Subsequent chest/abdominal/pelvic computed tomography did not reveal evidence of tumors, and diagnostic peritoneal/pelvic laparoscopy did not show diseases. Postoperatively, the patient received 6 cycles of chemotherapy consisting of carboplatin and paclitaxel, followed by radiation in the right groin. Malignant transformation from endometriosis occurs in less than 1% of endometriosis cases, and about 80% of the transformed tumors occur in the ovaries. The most commonly transformed malignant tumors are endometrioid and clear cell carcinomas, with rare adenosarcoma and endometrial stromal sarcoma reported. To our knowledge, we are reporting the first case of MMMT arising from endometriosis in the groin.
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Affiliation(s)
- Ruisheng Yao
- Department of Pathology, 22208Kent Hospital, Warwick, Rhode Island, USA.,Department of Pathology, 22209Women & Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Peter Wu
- Department of Pathology, 22208Kent Hospital, Warwick, Rhode Island, USA.,Department of Pathology, 22209Women & Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - C James Sung
- Department of Pathology, 22208Kent Hospital, Warwick, Rhode Island, USA.,Department of Pathology, 22209Women & Infants Hospital of Rhode Island, Providence, Rhode Island, USA.,Department of Pathology, Warren Alpert Medical School, 6752Brown University, Providence, Rhode Island, USA
| | - Jill A Lamson
- Department of Gynecologic Oncology, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Cunxian Zhang
- Department of Pathology, 22208Kent Hospital, Warwick, Rhode Island, USA.,Department of Pathology, 22209Women & Infants Hospital of Rhode Island, Providence, Rhode Island, USA.,Department of Pathology, Warren Alpert Medical School, 6752Brown University, Providence, Rhode Island, USA
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5
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Inoue N, Hirakawa T, Mitsushita J, Kitahara Y, Iwase A. Malignancies Associated with Extraovarian Endometriosis: A Literature Review. Endocrines 2021; 2:251-65. [DOI: 10.3390/endocrines2030024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Endometriosis-associated ovarian malignancies have been well documented. Although these malignancies also occur as extraovarian lesions, little is known about them. Thus, this literature review aimed to further explore these rarely experienced tumors. A total of 257 published cases between April 1990 and April 2020 were found using PubMed, and 212 cases were included in the analysis considering Sampson’s criteria and the history of endometriosis. We classified these cases as follows: intestine, abdominal scar, vagina and vulva, peritoneum and deep endometriosis, urinary tract, uterine cervix, and others. Age of patients, history of endometriosis, types of past hormonal therapy, symptoms, histological types, and treatment were identified. The most common tumor site was the intestine. Endometrioid carcinoma was the dominant histological type. Contrary to the ovary, clear cell carcinoma was rare in extraovarian sites. On the other hand, clear cell carcinoma represented the largest number of abdominal scars. This difference may help us to understand the development of endometriosis-related malignancies. Hormonal treatment was mentioned in 67 cases and estrogen replacement therapy in 33 cases. Although risks of estrogen therapy are still controversial, the highly differentiated histological types and hormone-dependent characteristics of endometriosis-associated malignancy should be considered. Physicians should be careful about estrogen monotherapy after hysterectomy and long-term hormone replacement therapy in patients with a history of endometriosis.
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6
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lac V, Verhoef L, Aguirre-Hernandez R, Nazeran TM, Tessier-Cloutier B, Praetorius T, Orr NL, Noga H, Lum A, Khattra J, Prentice LM, Co D, Köbel M, Mijatovic V, Lee AF, Pasternak J, Bleeker MC, Krämer B, Brucker SY, Kommoss F, Kommoss S, Horlings HM, Yong PJ, Huntsman DG, Anglesio MS. Iatrogenic endometriosis harbors somatic cancer-driver mutations. Hum Reprod 2019; 34:69-78. [PMID: 30428062 DOI: 10.1093/humrep/dey332] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 11/01/2018] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION Does incisional endometriosis (IE) harbor somatic cancer-driver mutations? SUMMARY ANSWER We found that approximately one-quarter of IE cases harbor somatic-cancer mutations, which commonly affect components of the MAPK/RAS or PI3K-Akt-mTor signaling pathways. WHAT IS KNOWN ALREADY Despite the classification of endometriosis as a benign gynecological disease, it shares key features with cancers such as resistance to apoptosis and stimulation of angiogenesis and is well-established as the precursor of clear cell and endometrioid ovarian carcinomas. Our group has recently shown that deep infiltrating endometriosis (DE), a form of endometriosis that rarely undergoes malignant transformation, harbors recurrent somatic mutations. STUDY DESIGN, SIZE, DURATION In a retrospective study comparing iatrogenically induced and endogenously occurring forms of endometriosis unlikely to progress to cancer, we examined endometriosis specimens from 40 women with IE and 36 women with DE. Specimens were collected between 2004 and 2017 from five hospital sites in either Canada, Germany or the Netherlands. IE and DE cohorts were age-matched and all women presented with histologically typical endometriosis without known history of malignancy. PARTICIPANTS/MATERIALS, SETTING, METHODS Archival tissue specimens containing endometriotic lesions were macrodissected and/or laser-capture microdissected to enrich endometriotic stroma and epithelium and a hypersensitive cancer hotspot sequencing panel was used to assess for presence of somatic mutations. Mutations were subsequently validated using droplet digital PCR. PTEN and ARID1A immunohistochemistry (IHC) were performed as surrogates for somatic events resulting in functional loss of respective proteins. MAIN RESULTS AND THE ROLE OF CHANCE Overall, we detected somatic cancer-driver events in 11 of 40 (27.5%) IE cases and 13 of 36 (36.1%) DE cases, including hotspot mutations in KRAS, ERBB2, PIK3CA and CTNNB1. Heterogeneous PTEN loss occurred at similar rates in IE and DE (7/40 vs 5/36, respectively), whereas ARID1A loss only occurred in a single case of DE. While rates of detectable somatic cancer-driver events between IE and DE are not statistically significant (P > 0.05), KRAS activating mutations were more prevalent in DE. LIMITATIONS, REASONS FOR CAUTION Detection of somatic cancer-driver events were limited to hotspots analyzed in our panel-based sequencing assay and loss of protein expression by IHC from archival tissue. Whole genome or exome sequencing, or epigenetic analysis may uncover additional somatic alterations. Moreover, because of the descriptive nature of this study, the functional roles of identified mutations within the context of endometriosis remain unclear and causality cannot be established. WIDER IMPLICATIONS OF THE FINDINGS The alterations we report may be important in driving the growth and survival of endometriosis in ectopic regions of the body. Given the frequency of mutation in surgically displaced endometrium (IE), examination of similar somatic events in eutopic endometrium, as well as clinically annotated cases of other forms of endometriosis, in particular endometriomas that are most commonly linked to malignancy, is warranted. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by a Canadian Cancer Society Impact Grant [701603, PI Huntsman], Canadian Institutes of Health Research Transitional Open Operating Grant [MOP-142273, PI Yong], the Canadian Institutes of Health Research Foundation Grant [FDN-154290, PI Huntsman], the Canadian Institutes of Health Research Project Grant [PJT-156084, PIs Yong and Anglesio], and the Janet D. Cottrelle Foundation through the BC Cancer Foundation [PI Huntsman]. D.G. Huntsman is a co-founder and shareholder of Contextual Genomics Inc., a for profit company that provides clinical reporting to assist in cancer patient treatment. R. Aguirre-Hernandez, J. Khattra and L.M. Prentice have a patent MOLECULAR QUALITY ASSURANCE METHODS FOR USE IN SEQUENCING pending and are current (or former) employees of Contextual Genomics Inc. The remaining authors have no competing interests to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- V Lac
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Rm G227, 2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada
| | - L Verhoef
- Department of Pathology of Antoni van Leeuwenhoek, Netherlands Cancer Institute, Plesmanlaan 121, CX Amsterdam, The Netherlands
| | - R Aguirre-Hernandez
- Contextual Genomics, 2389 Health Sciences Mall #204, Vancouver, British Columbia, Canada
| | - T M Nazeran
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada.,Department of Anatomical Pathology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, British Columbia, Canada
| | - B Tessier-Cloutier
- Department of Pathology and Laboratory Medicine, Rm G227, 2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Anatomical Pathology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, British Columbia, Canada
| | - T Praetorius
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada.,Department of Women's Health, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, Germany
| | - N L Orr
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, British Columbia, Canada.,BC Women's Centre for Pelvic Pain & Endometriosis, BC Women's Hospital and Health Centre, Women' Health Centre, F2-4500 Oak St, Vancouver, British Columbia, Canada
| | - H Noga
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, British Columbia, Canada.,BC Women's Centre for Pelvic Pain & Endometriosis, BC Women's Hospital and Health Centre, Women' Health Centre, F2-4500 Oak St, Vancouver, British Columbia, Canada
| | - A Lum
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada
| | - J Khattra
- Contextual Genomics, 2389 Health Sciences Mall #204, Vancouver, British Columbia, Canada
| | - L M Prentice
- Contextual Genomics, 2389 Health Sciences Mall #204, Vancouver, British Columbia, Canada
| | - D Co
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada
| | - M Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta, Canada
| | - V Mijatovic
- Academic Endometriosis Center VUmc, Department of Reproductive Medicine, VU University Medical Center, De Boelelaan 1117, HV Amsterdam, The Netherlands
| | - A F Lee
- Department of Pathology and Laboratory Medicine, Rm G227, 2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Pasternak
- Department of Women's Health, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, Germany
| | - M C Bleeker
- Academic Endometriosis Center VUmc, Department of Reproductive Medicine, VU University Medical Center, De Boelelaan 1117, HV Amsterdam, The Netherlands
| | - B Krämer
- Department of Women's Health, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, Germany
| | - S Y Brucker
- Department of Women's Health, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, Germany
| | - F Kommoss
- Institute of Pathology, Medizin Campus Bodensee, Roentgenstrasse 2, Friedrichshafen, Germany
| | - S Kommoss
- Department of Women's Health, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, Germany
| | - H M Horlings
- Department of Pathology of Antoni van Leeuwenhoek, Netherlands Cancer Institute, Plesmanlaan 121, CX Amsterdam, The Netherlands
| | - P J Yong
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, British Columbia, Canada.,BC Women's Centre for Pelvic Pain & Endometriosis, BC Women's Hospital and Health Centre, Women' Health Centre, F2-4500 Oak St, Vancouver, British Columbia, Canada
| | - D G Huntsman
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Rm G227, 2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Anatomical Pathology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, British Columbia, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, British Columbia, Canada
| | - M S Anglesio
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Rm G227, 2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, British Columbia, Canada
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9
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Abstract
In this study, the risk factors for ovarian endometriosis (OE) malignancy and its recurrence were explored in Chinese women. For OE malignancy occurrence, the age of marriage, abortion times, course of OE, body mass index (BMI), other benign uterine complications, and shorter parturition times were identified as risk factors using univariate analyses. Among them, age at marriage, course of OE, BMI, and decreased parturition times were identified as risk factors using multivariate analyses. For OE malignancy recurrence, the risk factors included clinical staging, histological classification, and chemotherapy by univariate analysis; and clinical stage, clear-cell carcinoma, and fewer chemotherapy cycles by multivariate analyses. In summary, we concluded that higher ages at marriage, longer courses of ovarian endometriosis, shorter parturition times, and additional benign uterine complications may increase the risk of OE malignancy. Advanced clinical stages, clear-cell carcinomas, and fewer chemotherapy cycles may promote OE malignancy recurrence. Impact statement What is already known on this subject? Endometriosis is one of the most common gynaecological diseases. Although endometriosis is not a malignant disease, endometriosis cells have characteristics similar to cancer cells. The risk of malignant transformation rates of ovarian endometriosis is said to be 1:18. However, epidemiological evidence based on large population research in ovarian endometriosis malignancy is lacking. In addition, there were few studies focussing on the long-term prognosis of ovarian endometriosis malignancies. What do the results of this study add? This study revealed the possible occurrence and recurrence risk factors of ovarian endometriosis malignancy using univariate and multivariate statistics analyses. What are the implications of these findings for clinical practice and/or further research? A clinical retrospective study with a longer follow-up period is suggested for assessing the occurrence and recurrence risk factors for ovarian endometriosis malignancies.
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Affiliation(s)
- Ying Zhang
- Department of Gynecology, Tianjin Central Hospital of Gynecology Obstetrics , Tianjin , China
| | - Pengpeng Qu
- Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology Obstetrics , Tianjin , China
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Tanase Y, Kawaguchi R, Uchiyama T, Kobayashi H. Long-Term Follow-Up after Surgical Management for Atypical Endometriosis: A Series of Nine Cases. Case Rep Oncol 2019; 12:76-83. [PMID: 30792646 PMCID: PMC6381887 DOI: 10.1159/000496178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 11/20/2022] Open
Abstract
Background and Objective Atypical endometriosis is reported to possess a precancerous potential attributed to premalignant changes characterized by cytological atypia and architecture proliferation. Although the coexistence of atypical endometriosis and neoplasms has been reported, cases of atypical endometriosis transformation to carcinoma are rarely reported. The purpose of this case series was to evaluate the prognosis of atypical endometriosis. Subjects and Methods Data from nine women who underwent surgical treatment including cystectomy and salpingo-oophorectomy with or without hysterectomy and diagnosed with atypical endometriosis was analyzed. Between January 2006 and January 2018, the clinical characteristics and prognosis of atypical endometriosis were evaluated. Results During the follow-up period, eight of nine patients with atypical endometriosis did not develop malignant epithelial tumors, although one patient developed endometrioid carcinoma, grade 1, 48 months after her right laparoscopic cystectomy. The median overall survival period for all patients was 68 (range 13–131) months. Conclusion When we encounter the cases of atypical endometriosis, it is necessary to consider the possibility of ovarian cancer and carefully follow those cases for long periods.
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Affiliation(s)
- Yasuhito Tanase
- Department of obstetrics and gynecology, Nara Medical University, Nara, Japan
| | - Ryuji Kawaguchi
- Department of obstetrics and gynecology, Nara Medical University, Nara, Japan
| | - Tomoko Uchiyama
- Department of diagnostic pathology, Nara Medical University, Nara, Japan
| | - Hiroshi Kobayashi
- Department of obstetrics and gynecology, Nara Medical University, Nara, Japan
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Zhang P, Sun Y, Zhang C, Yang Y, Zhang L, Wang N, Xu H. Cesarean scar endometriosis: presentation of 198 cases and literature review. BMC Womens Health 2019; 19:14. [PMID: 30658623 PMCID: PMC6339338 DOI: 10.1186/s12905-019-0711-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/03/2019] [Indexed: 11/26/2022]
Abstract
Background Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis (AWE). The aim of this study was to systematically identify the clinical features of CSE and recommend precautionary measures. Methods A large, retrospective study was undertaken with CSE patients treated surgically at our hospital between January 2005 and December 2017. Results A total of 198 CSE patients were enrolled, with a mean age of 32.0 ± 4.0 years. The main complaint of the patients was abdominal mass (98.5%), followed by cyclic pain (86.9%). The latency period of CSE was 31.6 ± 23.9 months, and the duration between the onset of symptoms and this surgery was 28.3 ± 25.0 months. A majority (80.8%, n = 160) of the patients had undergone a Pfannenstiel incision, and a minority (19.2%, n = 38) a vertical midline incision. The latency period of CSE in the case of a Pfannenstiel incision was significantly shorter than that in the case of a vertical midline incision (24.0 vs 33.0 months, P = 0.006). A total of 187 (94.4%) patients had a single endometrioma, 11 (5.6%) patients had multiple endometriomas, and the 11 multiple-endometrioma patients had all undergone a Pfannenstiel incision. Lesions of endometrioma were common in corner sites, after either incision: 142/171 (83.0%) in Pfannenstiel incision scars and 32/38 (84.2%) in vertical incision scars. Conclusions The findings of this study indicate that the Pfannenstiel incision carries a higher risk of CSE than the vertical midline incision. Thorough cleaning at the conclusion of CS, particularly of both corner sites of the adipose layer and the fascia layer, is strongly recommended for CSE prevention. Further studies might provide additional recommendations.
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Affiliation(s)
- Ping Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yabing Sun
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Chen Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yeping Yang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Linna Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Ningling Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China.
| | - Hong Xu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China.
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Amin K, Brumley B, Erickson BK, Khalifa MA. Müllerian carcinosarcoma arising from atypical pelvic endometriosis. Gynecol Oncol Rep 2018; 25:87-9. [PMID: 30014020 DOI: 10.1016/j.gore.2018.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/07/2018] [Accepted: 06/13/2018] [Indexed: 12/05/2022] Open
Abstract
Mullerian Carcinosarcoma (MC) is one of the rarest endometriosis associated malignancies (EAM). Atypical endometriosis can undergo variety of metaplastic changes causing diagnostic dilemma. Atypical endometriosis possibly represents a precursor lesion in the development of EAM.
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Abstract
In recent years we have seen an increase in the frequency of cesarean sections. We present a case report of an endometrioid adenocarcinoma arising from abdominal wall endometriosis in a patient with a history of cesarean sections and describe its diagnostic and therapeutic management.
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Affiliation(s)
- Marie Vinchant
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Paris-Seine-Saint-Denis, University Hospital Jean Verdier, Bondy, France
| | - Christophe Poncelet
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Paris-Seine-Saint-Denis, University Hospital Jean Verdier, Bondy, France
| | - Marianne Ziol
- Department of Pathology, Hôpitaux Universitaires de Paris-Seine-Saint-Denis, University Hospital Jean Verdier, Bondy, France
| | - Corinne Vons
- Department of General Surgery, Hôpitaux Universitaires de Paris-Seine-Saint-Denis, University Hospital Jean Verdier, Bondy, France
| | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Paris-Seine-Saint-Denis, University Hospital Jean Verdier, Bondy, France
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Liang JL, Liu XY, Qiu T, Fu ZQ, Wang HY, Kong X, Tao K. Microdissected thin anterolateral thigh perforator flaps with multiple perforators: A series of case reports. Medicine (Baltimore) 2018; 97:e9454. [PMID: 29369171 PMCID: PMC5794355 DOI: 10.1097/md.0000000000009454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The study aimed to explore the effect of microdissected thin anterolateral thigh (MTALT) perforator flap with multiple perforators on patients with complex defects on the hand, elbow, heel, or knee. METHODS From March 2012 to February 2013, 5 patients with complex defects on the hand, elbow, heel, or knee were included. During the flap preparation, 2 to 3 perforators penetrating the fascia of the anterolateral femoral area were initially detected, and the deep fascia was incised. The superficial fascia layer of the flap and the deep adipose were then dissected, and removed after verifying the distribution of the blood vessels using an operating microscope. The whole flap was then elevated, and transposed to the recipient areas for microsurgical reparation. RESULTS Two cases of post-burn scar contracture and 3 cases of traumatic tissue defects were successfully reconstructed with these multiple-perforator MTALT flaps. No complication was reported, and secondary operative procedure was not needed in any patient in the follow-up. CONCLUSION MTALT perforator flap with multiple perforators is safe and reliable for patients with complex defects on the hand, elbow, heel, or knee.
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Mihailovici A, Rottenstreich M, Kovel S, Wassermann I, Smorgick N, Vaknin Z. Endometriosis-associated malignant transformation in abdominal surgical scar: A PRISMA-compliant systematic review. Medicine (Baltimore) 2017; 96:e9136. [PMID: 29245355 PMCID: PMC5728970 DOI: 10.1097/md.0000000000009136] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Endometriosis-associated malignant transformation in abdominal surgical scar (EAMTAS) is a very rare and aggressive phenomenon. Our current article aims to provide a clinical overview, focusing on risk factors affecting survival. METHODS We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review based on prior reviews and case reports regarding the phenomenon published as abstracts in English, from January 1980 to November 2016. Overall, we identified 47 cases, and we included another case from our institution. We further contacted previous investigators to receive updated follow-up regarding their patients. We analyzed the data, focusing on risk factors that might affect overall survival. RESULTS All the patients reported in the literature had a uterine surgery, mainly caesarean section. The median time-lag from first surgery to the diagnosis of cancer was about 19 years. Clear-cell carcinoma (CCC) was the most prevalent histology (67%), followed by endometrioid adenocarcinoma (15%). Most of the patients were treated by extensive surgery and chemotherapy and/or radiation. Overall 5 years survival was about 40%. Median overall survival was 42 months (95% confidence interval of [18.7, 65.3]). Although our review is currently the largest in the literature, we cannot draw any statistical significant results due to the limited number of patients reported. According to univariate Cox-regression models, a tendency toward worse prognosis was shown for 3-year disease-free survival clear cell histologic-type (P = .169), and tumor diameter ≥8 cm in nonclear-cell histology, 18 months postdiagnosis (P = .06). CONCLUSION EAMTAS is a rare and aggressive disease. It is mostly related to cesarean section scars and is diagnosed many years postsurgery. Clear-cell histology tends to endure from the worse prognosis. The treatment is mainly extensive surgery and adjuvant chemotherapy and/or radiotherapy.
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Affiliation(s)
- Anca Mihailovici
- Departments of Obstetrics and Gynecology, Assaf-Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, affiliated to the Hebrew University School of Medicine, Jerusalem
| | | | - Ilan Wassermann
- General Surgery, Assaf-Harofeh Medical Center, Zerifin, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Smorgick
- Departments of Obstetrics and Gynecology, Assaf-Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - Zvi Vaknin
- Departments of Obstetrics and Gynecology, Assaf-Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv
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Krepelka P, Velebil P, Feyereisl J, Krofta L. A Retrospective Study of 17 Patients who Had Excision of Abdominal wall Endometriosis after Caesarean Section over an 11-Year Period. Journal of Endometriosis and Pelvic Pain Disorders 2017; 9:293-6. [DOI: 10.5301/jeppd.5000300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction The aim of our study was to retrospectively learn about the incidence of abdominal wall endometriosis (AWE) after caesarean section (CS) in our Perinatal Centre (Perinatal Centre of the Institute for the Care of Mother and Child), one of the largest in the Czech Republic. Methods This is a retrospective review of hospital records on 18,454 caesarean deliveries between 2003 and 2014. Results A total of 17 cases of caesarean scar endometriosis (also known as AWE) were identified. The median age was 36.0 (33.5-43.5) years. In 10 patients, the cyclic pain was present. The median interval between CS and first symptoms was 3.0 (1.0-6.5) years. Ultrasound supported the diagnosis by the identification of hypoechogenic lesions in all patients. The median interval between symptoms development and surgical excision was 1.0 year (1.0-4.0 years). Excision was the mode of treatment. Excisions with clear margins (15 cases) were curative to all those patients. Two patients with involved margins had recurrences at 6 and 8 months, respectively, and were treated with a second resection with no further surgery. No malignant transformation cases were identified. Conclusions Physicians should be highly suspicious of CS scar endometriosis, especially after uterine surgery. Complete excision is the only curative treatment.
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Abstract
OBJECTIVE Endometriosis-associated abdominal wall cancer (EAAWC) is rare, and few reports are available. This article provides a review of reports in the literature on the pathology, diagnosis, management, and outcome of patients with EAAWC. METHOD We performed a review of existing reports in the English language literature on cancer arising from abdominal wall endometriosis. MEDLINE and EMBASE searches were conducted for articles published from September 1986 to August 2014 using combinations of medical subject heading terms. RESULTS We identified 26 articles reporting on EAAWC and added 1 patient who was treated at our institution. In all of these patients, EAAWC was described after uterine surgery (mostly cesarean section). The delay between the first surgery and the diagnosis of malignant disease was more than 20 years. Clear cell carcinoma was the most common histology, followed by endometrioid carcinoma. Death was described in 44% of women within a few months of diagnosis. CONCLUSIONS Endometriosis-associated abdominal wall cancer is rare and aggressive. It seems to be associated with cesarean section, and it shows poor prognosis. The mainstay of treatment remains extensive surgery and chemotherapy.
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Vukšić T, Rastović P, Dragišić V. Abdominal Wall Endometrioma after Laparoscopic Operation of Uterine Endometriosis. Case Rep Surg 2016; 2016:5843179. [PMID: 27340586 DOI: 10.1155/2016/5843179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 04/06/2016] [Indexed: 11/17/2022] Open
Abstract
Endometriosis is presence of functional endometrium outside of uterine cavum. As a pluripotent tissue, endometrium has the possibility of implanting itself almost everywhere; even implantation in abdominal wall was described, but it is not common site. This case report presents implantation of functional endometrium in abdominal wall, inside scar tissue, and after insertion of a laparoscopic trocar port. Final diagnosis was confirmed by pathohistological examination.
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Sosa-Durán EE, Aboharp-Hasan Z, Mendoza-Morales RC, García-Rodríguez FM, Jiménez-Villanueva X, Peñavera-Hernández JR. Clear cell adenocarcinoma arising from abdominal wall endometriosis. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.circen.2016.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Background: Endometriosis is defined as an estrogen-dependent, benign inflammatory disease characterized by the presence of ectopic endometrial implants. Abdominal wall endometrioma (AWE) being a rare entity is a benign tumor defined as ectopic functional, endometrial tissue located in the abdominal wall. Subjects and Methods: A retrospective study of 23 female patients treated with AWE in four departments of three centers in Vladimir city, Russia, from January 2010 to December 2014 was performed. Results: In twenty patients (87%), AWE was symptomatic, and in three patients (13%), AWE was asymptomatic. Esquivel triad presented in 17 patients (74%), and modified Esquivel triad existed in 20 patients (87%). All 23 patients were operated, and AWE excision was performed. Recurrence occurred in 4 cases (17.4%) and was associated with postoperative pain and seroma. Conclusion: Postoperative pain for more than 7 days and seroma (on ultrasonography) seem to be associated with recurrence of AWE.
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Affiliation(s)
- Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Roman Horta
- Department of Gynecology, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Dmitriy Afanasyev
- Ambulatory Surgery Center, Vladimir City Clinical Hospital No. 5, Vladimir, Russia
| | - Timur Gilyazov
- Department of General Surgery, Oblast Clinical Hospital, Vladimir, Russia
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Kiuchi K, Hasegawa K, Kanamori A, Machida H, Kojima M, Fukasawa I. Carcinosarcoma arising from uterine adenomyosis: A case report. J Obstet Gynaecol Res 2015; 42:358-62. [PMID: 26663238 DOI: 10.1111/jog.12901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/06/2015] [Accepted: 10/05/2015] [Indexed: 11/30/2022]
Abstract
Carcinosarcoma arising from uterine adenomyosis is extremely rare. We encountered such a patient and herein provide a review of the literature. A 56-year-old woman was referred for a huge pelvic tumor, suspected to be an advanced uterine leiomyosarcoma. Intraoperative inspection revealed a mass, mainly located in the uterine myometrium, invading the uterine serosa. The tumor had previously spontaneously ruptured and disseminated to the pelvic cavity. Pathological and immunohistochemical examination revealed an infiltrative pattern of biphasic tumor cells composed of endometrioid adenocarcinoma and a nonepithelial component with rhabdomyosarcomatous differentiation. Benign endometrial glands with stromal cells were found adjacent to the area of the carcinosarcoma. The endometrium and both ovaries and fallopian tubes were microscopically free of tumor cells. The final diagnosis was heterologous type carcinosarcoma with rhabdomyosarcomatous differentiation, originating from uterine adenomyosis.
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Affiliation(s)
- Kaori Kiuchi
- Department of Obstetrics and Gynecology, Dokkyo Medical University, Mibu, Japan
| | - Kiyoshi Hasegawa
- Department of Obstetrics and Gynecology, Dokkyo Medical University, Mibu, Japan
| | - Anriko Kanamori
- Department of Obstetrics and Gynecology, Dokkyo Medical University, Mibu, Japan
| | - Hiromi Machida
- Department of Pathology, Dokkyo Medical University, Mibu, Japan
| | - Masaru Kojima
- Department of Anatomic and Diagnostic Pathology, Dokkyo Medical University, Mibu, Japan
| | - Ichio Fukasawa
- Department of Obstetrics and Gynecology, Dokkyo Medical University, Mibu, Japan
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Sosa-Durán EE, Aboharp-Hasan Z, Mendoza-Morales RC, García-Rodríguez FM, Jiménez-Villanueva X, Peñavera-Hernández JR. [Clear cell adenocarcinoma arising from abdominal wall endometriosis]. CIR CIR 2015; 84:245-9. [PMID: 26272425 DOI: 10.1016/j.circir.2015.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/27/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Clear cell carcinoma originating in the abdominal wall is a rare event. It is generally associated with endometrial tissue implants left behind after a caesarean section or other gynaecological operations. Its pathophysiology is complex and controversial. CLINICAL CASE The case is presented of a 45 year-old female with history of three caesarean sections, who was seen due to having a tumour mass of 6 months onset in the anterior abdominal wall. Imaging studies confirmed its location, and due to measuring 9 by 7 cm it was suspected to be an urachal tumour. A resection with wide margins was performed. The histopathology report was of a clear cell adenocarcinoma originated in ectopic endometrial tissue, with negative margins. CONCLUSION This is a very rare case, with few cases reported in the literature. This diagnosis should be included in tumours of the abdominal wall.
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Affiliation(s)
- Erik Efraín Sosa-Durán
- Unidad de Oncología, Hospital Juárez de México, Secretaría de Salud, México, D.F. , México.
| | - Ziad Aboharp-Hasan
- Unidad de Oncología, Hospital Juárez de México, Secretaría de Salud, México, D.F. , México
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Jiang M, Chen P, Sun L, Huang Q, Wu H. 18F-FDG PET/CT Findings of a Recurrent Adenocarcinoma Arising From Malignant Transformation of Abdominal Wall Endometriosis. Clin Nucl Med 2015; 40:184-5. [DOI: 10.1097/rlu.0000000000000631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ijichi S, Mori T, Suganuma I, Yamamoto T, Matsushima H, Ito F, Akiyama M, Kusuki I, Kitawaki J. Clear cell carcinoma arising from cesarean section scar endometriosis: case report and review of the literature. Case Rep Obstet Gynecol 2014; 2014:642483. [PMID: 25530894 DOI: 10.1155/2014/642483] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 10/08/2014] [Indexed: 11/24/2022] Open
Abstract
Introduction. The incidence of endometriosis affecting skin tissue represents only 0.5–1.0% of all endometriosis cases. A malignancy in the abdominal wall arising from endometriosis following cesarean section is even rarer; only 21 cases have previously been reported. The therapeutic strategy has not been determined because of the limited cases. We report a case of clear cell adenocarcinoma arising in the abdominal wall from endometriosis tissues following cesarean section and review previous literature to achieve the optimal treatment and better prognosis. Case Presentation. A 60-year-old woman presented with a growing mass at the left side of a cesarean section scar. Radical resection of the abdominal wall mass was performed. Histopathological examination showed a clear cell adenocarcinoma. Benign endometrium-like tissues were found adjacent to the cancer lesion in the excised specimen, suggesting malignant transformation from endometriosis of the abdominal wall. Discussion. Local resection was performed in 10 cases (47.6%) and total abdominal hysterectomy or oophorectomy was conducted in 11 cases (52.4%). No malignant lesions were observed in either the uterus or adnexa that were resected. These cases may be expected to increase with increasing incidence of cesarean section. The significance of the extensional resection should be further elucidated.
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Fargas Fàbregas F, Cusidó Guimferrer M, Tresserra Casas F, Baulies Caballero S, Fábregas Xauradó R. Malignant transformation of abdominal wall endometriosis with lymph node metastasis: Case report and review of literature. Gynecol Oncol Case Rep 2014; 8:10-3. [PMID: 24567887 PMCID: PMC3930813 DOI: 10.1016/j.gynor.2013.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/26/2013] [Indexed: 11/26/2022]
Abstract
A simple endometriosis can result in malignancy pathology, as a neoplasia. Wall-abdominal tumors and soft tissue as a possible differential diagnosis of abdominal wall endometriosis Preperitoneal node-metastasis as malignancy of endometriosis in previous cesarean scar
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Stojanovic M, Brasanac D, Stojicic M. Cutaneous Inguinal Scar Endosalpingiosis and Endometriosis: Case Report With Review of Literature. Am J Dermatopathol 2013; 35:254-60. [DOI: 10.1097/dad.0b013e3182726e09] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mistrangelo M, Gilbo N, Cassoni P, Micalef S, Faletti R, Miglietta C, Brustia R, Bonnet G, Gregori G, Morino M. Surgical scar endometriosis. Surg Today 2013; 44:767-72. [PMID: 23307296 DOI: 10.1007/s00595-012-0459-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/24/2012] [Indexed: 11/24/2022]
Abstract
Endometriosis is a common disorder in females of reproductive age. Surgical scar endometrioma after cesarean section develops in 1-2% of patients, and usually presents as a tender and painful abdominal wall mass. The diagnosis is suggested by pre or perimenstrual pelvic pain and is often established only by histology. In this retrospective observational cohort study, we reviewed the medical records of five patients with a histopathological diagnosis of scar endometriosis. A scar mass was found on a previous Pfannenstiel incision in four patients and in a median cesarean section in one patient. The mean age at diagnosis (38.6 years, median 38) was older than reported elsewhere. A histological examination of the surgical specimen confirmed the diagnosis of endometriosis in all cases. During the follow-up period (mean 34.6 months), local recurrence (n = 1) and pelvic recurrence (n = 1) were treated surgically. Surgery is the treatment of choice for surgical scar endometriosis. Excision with histologically proven free surgical margins of 1 cm is mandatory to prevent recurrence. As scar endometriosis may be associated with pelvic localization, explorative abdominal laparoscopy may be indicated to exclude the intraperitoneal spread of the disease in symptomatic patients.
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Affiliation(s)
- Massimiliano Mistrangelo
- Department of Digestive and Colorectal Surgery, Centre of Minimal Invasive Surgery, Molinette Hospital, University of Turin, Cso A.M. Dogliotti 14, 10126, Turin, Italy,
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Sawazaki H, Goto H, Takao N, Taki Y, Takeuchi H. Clear cell adenocarcinoma arising from abdominal wall endometriosis mimicking urachal tumor. Urology 2012; 79:e84-5. [PMID: 22656428 DOI: 10.1016/j.urology.2011.02.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/21/2011] [Accepted: 02/21/2011] [Indexed: 11/30/2022]
Abstract
A 41-year-old woman presented with severe lower abdominal pain. She had a history of 2 cesarean deliveries. Magnetic resonance imaging (MRI) revealed a 4.3 × 4.6 × 4.8-cm mass on the urinary bladder dome. Preoperative diagnosis was invasive urachal tumor. Wide resection of the tumor was performed. The histopathological diagnosis was clear cell adenocarcinoma with endometriosis. MRI revealed normal-sized ovaries and uterus. The definite diagnosis of clear cell carcinoma arising from abdominal wall endometriosis was made. Adjuvant chemotherapy with paclitaxel and carboplatin (total 6 courses) was planned. The patient has thus far received 4 courses of this treatment.
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Shalin SC, Haws AL, Carter DG, Zarrin-Khameh N. Clear cell adenocarcinoma arising from endometriosis in abdominal wall cesarean section scar: a case report and review of the literature. J Cutan Pathol 2012; 39:1035-41. [DOI: 10.1111/j.1600-0560.2012.01982.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 04/23/2012] [Accepted: 06/10/2012] [Indexed: 01/10/2023]
Affiliation(s)
- Sara C. Shalin
- Department of Pathology and Immunology; Baylor College of Medicine; Houston; TX; 77030; USA,
| | - Andrea L. Haws
- Department of Pathology and Immunology; Baylor College of Medicine; Houston; TX; 77030; USA,
| | - Dornechia G. Carter
- Department of Dermatology; Baylor College of Medicine; Houston; TX; 77030; USA
| | - Neda Zarrin-Khameh
- Department of Pathology and Immunology; Baylor College of Medicine; Houston; TX; 77030; USA,
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Abstract
Endometriosis is the leading cause of morbidity among premenopausal women affecting about 1 in 10 females. The features shared by endometriosis and cancer include the ability to evade apoptosis, the stem cell-like ability and angiogenic potential. As such characteristics are encoded by the cell's genetic constitution, acquired mutations are responsible for the malignant transformation of endometriosis. Indeed, a number of tumour-suppressor genes and proto-oncogenes, such as protein 53 (P53) and B-cell lymphoma 2 (BCL-2) respectively, are mutated and as a result differentially expressed between endometriotic and malignant tissue associated with endometriosis. Moreover, cytokines and macrophages, both of which are inflammatory mediators have been implicated in the transformation process. The angiogenic properties possessed by cancer arising from endometriosis signifies a bad prognosis, while the stem cell-like activity possessed by both endometriosis and cancer has been attributed to the effect of oestrogen. A number of differences between endometriosis and cancer are found at the molecular level. Considering the link between these two pathologies, the three components which fuel the malignant transformation of endometriosis can be embodied in the endometriosis-induced carcinoma (EIC) triangle which shows the intricate relationship between endocrinologic, immunologic and genetic components.
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Affiliation(s)
- Joel Pollacco
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Msida, MSD 2080, Malta
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Abstract
Endometriosis is a common gynaecological condition that usually presents as an abdominal lump. It can be a diagnostic dilemma and should be considered as a differential diagnosis for lumps in the abdomen in females. We discuss a case of abdominal wall endometriosis following caesarean section, which was misdiagnosed as a desmoid tumour.
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Affiliation(s)
- Mani Anand
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, India
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Abstract
Malignant transformation of a uterine leiomyoma is an exceedingly rare phenomenon. Previous reported examples of malignant neoplasms to arise so include leiomyosarcoma, angiosarcoma, and malignant mesenchymoma. We report an intramural carcinosarcoma arising in a uterine leiomyoma in a 38-year-old woman. This case is unique in being the first recorded carcinosarcoma arising within a uterine leiomyoma and the first example of an epithelial neoplasm to do so. We discuss the differential diagnosis and possible pathogenesis of the tumor that has likely arisen secondary to epitheliogenesis in a mesenchymal neoplasm.
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Yan Y, Li L, Guo J, Zheng Y, Liu Q. Malignant transformation of an endometriotic lesion derived from an abdominal wall scar. Int J Gynaecol Obstet. 2011;115:202-203. [PMID: 21872248 DOI: 10.1016/j.ijgo.2011.06.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 06/17/2011] [Accepted: 07/28/2011] [Indexed: 02/07/2023]
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Nissotakis C, Zouros E, Revelos K, Sakorafas GH. Abdominal wall endometrioma: a case report and review of the literature. AORN J 2010; 91:730-42; quiz 743-5. [PMID: 20510946 DOI: 10.1016/j.aorn.2010.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 01/06/2010] [Accepted: 01/15/2010] [Indexed: 11/30/2022]
Abstract
Endometriosis is the presence of ectopic endometrial tissue that can respond to ovarian hormonal stimulation. Although it is uncommon, extrapelvic endometriosis can form a discrete mass known as an abdominal wall endometrioma. Endometriomas are thought to be caused by transfer of endometrial cells into a surgical wound, most often after a cesarean delivery. Endometriomas are diagnosed via ultrasound, computed tomography, magnetic resonance imaging, and ultrasound-guided fine needle aspiration. Treatment options can be medical, but surgical excision is the treatment of choice. Perioperative nursing care includes patient teaching, taking steps to prevent surgical site infection and inadvertent hypothermia, ensuring availability of supplies (eg, the graft for abdominal wall repair if needed), and postoperative pain management.
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Drukała Z, Ciborowska-Zielińska B, Kubrak J, Rogowska D. Outcome of a multimodal therapy of a recurrent adenocarcinoma arising from Caesarean section scar endometriosis-A case report. Rep Pract Oncol Radiother 2010; 15:75-7. [PMID: 24376928 DOI: 10.1016/j.rpor.2010.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 03/20/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endometriosis occurring in surgical scars is a well-described entity. Malignant transformation of endometriosis is a rare event, with most cases belonging to adenocarcinoma. The initial surgical treatment is a method of choice. Due to lack of therapeutic recommendations, adjuvant therapy and recurrence management are a great challenge for oncologists. AIM The aim of this paper was to present a long-term survival as the outcome of multimodal therapy in the patient with recurrent adenocarcinoma arising from Caesarean section scar endometriosis. CASE We present the case of a woman with recurrent adenocarcinoma arising from Caesarean section scar endometriosis. The disease was first diagnosed in September 1997 at age 43. The patient underwent abdominal hysterectomy with tumour excision. Due to a local recurrence after 4 years, tumour excision with abdominal wall repair using a plastic mesh, regional lymphadenectomy, bilateral salpingo-ovariectomy and adjuvant radiotherapy for the pelvic region with local boost were performed; in addition hormontherapy with medroxyprogesterone was started. Because of a recurrent pelvic tumour, chemotherapy, further local palliative radiotherapy and brachytherapy were administered. Subsequently distant metastases in bilateral axillary lymph nodes were diagnosed and palliative radiotherapy was performed. The patient died of morbus neoplasmaticus generalisatus in September 2008. The follow-up period had been 132 months. CONCLUSION This paper is, to our knowledge, the only report in literature that presents a long-term survival as the outcome of multimodal therapy in the patient with this rare diagnosis. Further reports of new cases can help establish optimal treatment guidelines.
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Affiliation(s)
- Zbigniew Drukała
- Department of Radiotherapy, West Pomeranian Oncology Centre, Szczecin, Poland
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Pencavel T, Strauss D, Thomas J, Hayes A. The surgical management of soft tissue tumours arising in the abdominal wall. Eur J Surg Oncol 2010; 36:489-95. [DOI: 10.1016/j.ejso.2010.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 03/15/2010] [Accepted: 03/18/2010] [Indexed: 12/22/2022] Open
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Bourdel N, Durand M, Gimbergues P, Dauplat J, Canis M. Exclusive nodal recurrence after treatment of degenerated parietal endometriosis. Fertil Steril 2010; 93:2074.e1-6. [PMID: 20045513 DOI: 10.1016/j.fertnstert.2009.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 11/03/2009] [Accepted: 11/04/2009] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To report a case of endometriosis degenerated into clear cell carcinoma with positron-emission tomography (PET) scan staging. DESIGN Case report. SETTING University hospital. PATIENT(S) A 43-year-old woman diagnosed with endometriosis degenerated into clear cell carcinoma with nodal metastasis at the initial diagnosis and exclusive nodal recurrence 6 months after surgery. INTERVENTION(S) Resection of the mass with partial resection of the pubic symphysis and bilateral external iliac lymphadenectomy. Forty-five days later, hysterectomy with bilateral adnexectomy and then adjuvant chemotherapy and abdominal-pelvic radiotherapy. MAIN OUTCOME MEASURE(S) The PET scan showed positive lymph nodes in the cervical, supraclavicular, bilateral axillary, bilateral inguinal, and lumbar-aortic regions. RESULT(S) The patient experienced a tumor recurrence after 6 months. After surgical management, she was scheduled to receive six cycles of rescue chemotherapy. She died 22 months after the initial diagnosis. CONCLUSION(S) The use of PET scan could allow better staging at the initial diagnosis and improve follow-up in such patients. The treatment of this entity is based on radical surgery associated with adjuvant chemotherapy and radiotherapy, but the results are not satisfactory.
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Affiliation(s)
- Nicolas Bourdel
- CHU Clermont Ferrand, Department of Obstetrics and Gynecology, La Polyclinique, Clermont-Ferrand, France.
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Omranipour R, Najafi M. Papillary serous carcinoma arising in abdominal wall endometriosis treated with neoadjuvant chemotherapy and surgery. Fertil Steril 2010; 93:1347.e17-8. [PMID: 20079892 DOI: 10.1016/j.fertnstert.2009.09.065] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 09/27/2009] [Accepted: 09/28/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report a case of malignant transformation of abdominal wall endometriosis. DESIGN Case report. SETTING Private practice. PATIENT(S) A 59-year-old woman with a rapidly growing abdominal wall mass. INTERVENTION(S) Neoadjuvant chemotherapy and surgical resection of the mass. MAIN OUTCOME MEASURE(S) Shrinkage of the tumor after neoadjuvant chemotherapy and wide excision and reconstruction of abdominal wall. RESULT(S) A 59-year-old woman had a history of laparotomy performed for uterine perforation due to dilatation and curettage 20 years ago. She noticed a mass in her abdominal wall shortly after the operation, which changed in size with menstrual cycles. The mass showed a rapid growth in the last 6 months before presentation. Incisional biopsy revealed papillary serous carcinoma. Owing to the large size of the mass, the patient received neoadjuvant chemotherapy and underwent surgery after shrinkage of the mass. CONCLUSION(S) Malignant transformation of endometriosis is a rare event. In case of huge tumors, neoadjuvant chemotherapy might facilitate surgery by shrinking the tumor.
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Busard MPH, Mijatovic V, van Kuijk C, Hompes PGA, van Waesberghe JHTM. Appearance of abdominal wall endometriosis on MR imaging. Eur Radiol 2009; 20:1267-76. [PMID: 19936757 PMCID: PMC2850520 DOI: 10.1007/s00330-009-1658-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 10/05/2009] [Accepted: 10/14/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Abdominal wall endometriosis (AWE) is defined as endometrial tissue that is superficial to the peritoneum. AWE is often difficult to diagnose, mimicking a broad spectrum of diseases. The aim of this study was to describe the appearance of AWE on magnetic resonance (MR) imaging. METHODS We present ten patients with AWE (12 lesions) in which MR imaging was used for diagnosis. MR imaging included T2-weighted imaging and T1-weighted imaging with fat suppression. To assess the value of diffusion-weighted imaging (DWI) in endometriosis, four patients underwent additional DWI. The apparent diffusion coefficient (ADC) was calculated using b values of 50, 400, 800 and 1,200 s/mm(2). RESULTS In most cases, the lesion was located ventral or dorsal to the aponeurosis of the rectus oblique muscle (n = 6) or in the rectus abdominis (n = 5). MR of AWE lesions showed isointense or slightly hyperintense signal compared with muscle on T2-weighted images and showed isointense or slightly hyperintense signal compared with muscle on T1-weighted images with foci of high signal intensity, indicative of haemorrhage. The mean ADC value of AWE was 0.93 x 10(-3)/mm(2)/s. CONCLUSION MR imaging seems to be useful in determining the location and depth of infiltration in surrounding tissue preoperatively.
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Affiliation(s)
- Milou P H Busard
- Department of Radiology, Endometriosis Center VUMC, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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Abstract
Medical records of 32 women with abdominal incision endometriosis who underwent surgical treatment in the Obstetrics and Gynaecology Hospital at Fudan University between September 1999 and March 2006 were reviewed retrospectively. All cases concerning the diagnosis of endometriosis were confirmed by two gynaecological pathologists. The median age was 32 years (range from 25 to 45). A total of 31 patients had a history of caesarean section, and one case underwent ovarian endometrioid cystectomy. All abdominal incision endometriosis presented with a mass in the abdominal scar. Among them, there were 30 patients who complained of cyclical pain during menses. All of the 32 cases underwent surgical treatment and had follow-up from 10 months to 6 years; there was no recurrence of endometriosis in 31 cases. Abdominal incision endometriosis is rare in women and most cases present following caesarean section. It is suggested that during caesarean section, precautions need to be taken to avoid transplantation of endometrium into the abdominal incision. Surgical treatment is recommended to excise the lesion completely. The frozen section is performed during the operation due to the possibility of malignancy in abdomen incision endometriosis.
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Affiliation(s)
- Z Zhu
- Obstetrics and Gynecology Hospital at Fudan University, Shanghai, China
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Matsuo K, Alonsozana ELC, Eno ML, Rosenshein NB, Im DD. Primary peritoneal clear cell adenocarcinoma arising in previous abdominal scar for endometriosis surgery. Arch Gynecol Obstet 2009; 280:637-41. [DOI: 10.1007/s00404-009-0962-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 01/20/2009] [Indexed: 11/29/2022]
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Achach T, Rammeh S, Trabelsi A, Ltaief R, Ben Abdelkrim S, Mokni M, Korbi S. Clear cell adenocarcinoma arising from abdominal wall endometriosis. J Oncol 2008; 2008:478325. [PMID: 19266089 DOI: 10.1155/2008/478325] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Revised: 09/16/2008] [Accepted: 11/21/2008] [Indexed: 11/17/2022]
Abstract
Endometriosis is a frequent benign disorder. Malignancy arising in extraovarian endometriosis is a rare event. A 49-year-old woman is presented with a large painful abdominal wall mass. She underwent a myomectomy, 20 years before, for uterus leiomyoma. Computed tomography suggested that this was a desmoid tumor and she underwent surgery. Histological examination showed a clear cell adenocarcinoma associated with endometriosis foci. Pelvic ultrasound, computed tomography, and endometrial curettage did not show any malignancy or endometriosis in the uterus and ovaries. Adjuvant chemotherapy was recommended, but the patient was lost to follow up. Six months later, she returned with a recurrence of the abdominal wall mass. She was given chemotherapy and then she was reoperated.
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Bats AS, Zafrani Y, Pautier P, Duvillard P, Morice P. Malignant transformation of abdominal wall endometriosis to clear cell carcinoma: case report and review of the literature. Fertil Steril 2008; 90:1197.e13-6. [DOI: 10.1016/j.fertnstert.2007.08.080] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 08/29/2007] [Accepted: 08/31/2007] [Indexed: 10/22/2022]
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KAUPPILA SAILA, ALTINÖRS MEHMET, VÄRE PÄIVI, LIAKKA ANNIKKI, KNUUTI EILA, NISSI RITVA. Primary sex cord-like variant of endometrioid adenocarcinoma arising from endometriosis. APMIS 2008; 116:842-5. [DOI: 10.1111/j.1600-0463.2008.00806.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Endometriosis affects a wide spectrum of premenopausal women. Intestinal involvement, affecting mainly the large bowel and sometimes the small bowel, is much less frequent. Diagnosis is relatively straightforward in women with long standing pelvic endometriosis but is difficult in acute intestinal obstruction, since a diagnosis of endometriosis is not often considered in this entity. We performed an exhaustive review of the medical literature, including the option of medical treatment, which is rarely effective in intestinal endometriosis. In most patients with intestinal symptoms, the disease is so severe that surgical treatment is required. Recent studies indicate that the most effective approach is laparoscopic. We analyze the most important classical and recent series of patients and discuss treatment results.
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Affiliation(s)
- Alberto Bianchi
- Servicio de Cirugía General, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, España.
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Wicherek L, Klimek M, Skret-Magierlo J, Czekierdowski A, Banas T, Popiela TJ, Kraczkowski J, Sikora J, Oplawski M, Nowak A, Skret A, Basta A. The obstetrical history in patients with Pfannenstiel scar endometriomas--an analysis of 81 patients. Gynecol Obstet Invest 2006; 63:107-13. [PMID: 17028436 DOI: 10.1159/000096083] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 08/08/2006] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The participation of immune tolerance during pregnancy was suggested to be an important factor predisposing to the implantation of decidual cells after cesarean section in Pfannenstiel scar. Delivery at term is related to the termination of immune tolerance to fetal antigens that is maintained throughout pregnancy. Substantial proportion of cesarean section deliveries is performed before the onset of true term labor. The aim of this study was to analyze the clinical symptoms of spontaneous beginning of labor in pregnant women in whom cesarean sections were performed and in whom Pfannenstiel scar endometriomas were observed during follow-up. MATERIALS AND METHODS We have retrospectively analyzed 81 patients following the surgical removal of scar endometrioma after cesarean section. Obstetrical histories of cesarean sections in the number of 5,370 preceding the occurrence of the scar endometrioma were analyzed. These data were collected in six different Gynecological and Obstetrical wards in Malopolska Province in Poland. Analysis of data was started by the retrospective evaluation of regular uterine contractions, uterine cervix ripening before cesarean section and the indications for surgery. RESULTS In 67 women from the group of 81 patients cesarean sections were performed with unripe uterine cervix and without the presence of regular uterine contractions. Elective indications for cesarean sections were predominant in this group of women. The relative risk of scar endometriomas occurrence following cesarean sections performed before onset of labor in comparison to cesarean sections following spontaneous onset of labor was statistically significantly higher [RR = 2.16, 95% CI = 1.21-3.83; OR = 2.18, 95% CI = 1.22-3.89]. CONCLUSIONS Cesarean section performed before spontaneous onset of labor may increase substantially the risk of occurrence of scar endometriomas.
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Affiliation(s)
- Lukasz Wicherek
- Department of Gynecology and Infertility, Jagiellonian University, Krakow, Poland.
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