Abdominal wall endometrioma: Case report

Background: Endometriosis is a disease that presents primarily with pelvic pain and infertility. Endometrioma is a cyst consisting of endometrial glands and stoma and is typically an advanced presentation of endometriosis. Endometriomas usually grow benignly. There are few reports of patients with endometrioma with malignant features reported in the literature. A case of infrequent occurrence and low diagnostic rate will be reported but having as its origin a relatively common disease with great impact on the female population in reproductive age. Case Summary: A 54-year-old female patient came in with abdominal wall bulging referring to gradual growth and emergence over the last 4 years. Personal history includes previous cesarean section 2 decades ago. The patient also had hypertension, diabetes, a history of total thyroidectomy for thyroid neoplasia 18 years ago, bile duct lithiasis, uterine myomatosis, obesity and epilepsy that started a few years ago with no defined etiology. We report a case of endometrioid pattern adenocarcinoma of the abdominal wall. The patient was submitted to exploratory laparotomy with resection of the tumor in the abdominal wall besides extended hysterectomy, umbilical herniorrhaphy and cholecystectomy. The procedure was performed under general anesthesia and spinal anesthesia, laparoscopically with a report of cystography and bilateral pelvic lymphadenectomy. The patient was followed up as an outpatient, with adjuvant chemotherapy using the carboplatin and paclitaxel protocol. Conclusion: This report highlights a case of endometriosis with abdominal wall metaplastic invasion, an uncommon finding in everyday medical practice. Core Tip: The study consists of a case report of a patient presenting with endometriosis with abdominal wall invasion with elements of conversion to malignant disease and is considered an atypical case rarely reported in the literature. As a result, it may highlight a condition that in its early stages can be treated relatively easily but often goes unnoticed until advanced stages where it is no longer possible to treat it effectively.