Malignant transformation of abdominal wall endometriosis to clear cell carcinoma: case report

João Kleber de Almeida Gentil, Renato Migliore, Fábio Jorge Neubaner Kistenmacker, Marcio Menezes De Oliveira, Rodrigo Biscuola Garcia, Fang Chia Bin
In: instacron:APM · 2018 · W7120381205
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A 42-year-old woman with prior abdominal wall endometriosis resection developed clear cell carcinoma with external iliac lymph node metastasis, which was treated via mass and lymphadenectomy resection.

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This case report describes a 42-year-old woman who developed a large abdominal wall mass following previous surgery to resect endometriosis. Imaging and histological analysis confirmed that the solid tumor was a clear cell adenocarcinoma arising from malignant transformation of an endometriotic focus, with evidence of lymph node metastasis. The patient underwent block resection of the tumor along with lymphadenectomy and abdominal wall reconstruction, remaining disease-free after eight months of follow-up. This paper is centrally about endometriosis — specifically the rare complication of its malignant transformation into clear cell carcinoma within an abdominal wall scar.

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Abstract

BACKGROUND: Malignant transformation of endometriosis in the abdominal wall is a rare and still poorly understood event. Less than 30 cases have been reported in the worldwide literature. Most cases of solid tumors are report in a previous abdominal scar with malignant transformation of a focus of endometriosis. Presence of lymph node metastases in nearby chains is frequent and is associated with poor prognosis. CASE REPORT: We report a case of a 42-year-old woman with a history of abdominal surgery (Pfannen- stiel) to resect abdominal wall endometriosis. Physical examination revealed a solid mass of approximately 10 cm x 6 cm in the anterior wall of the abdomen. Computed tomography (CT) of the abdomen and pel- vis showed a heterogeneous, predominantly hypoattenuating expansive formation measuring 10.6 cm x 4.7 cm x 8.3 cm. The patient underwent exploratory incisional laparotomy, block resection of the abdomi- nal mass and lymphadenectomy of the external and inguinal iliac chains. The abdominal wall was recon- structed using a semi-absorbable tissue-separating screen to reconstitute the defect caused by resection of the tumor. Histological evaluation revealed infiltration by malignant epithelioid neoplasia, thus confirm- ing the immunohistochemical profile of adenocarcinoma with clear cell components. Lymphadenectomy showed metastatic involvement of an external iliac chain lymph node. CONCLUSION: Resection of the mass along with the abdominal wall, with wall margins, is the most effec- tive treatment. Reconstruction is a challenge for surgeons. The patient has been followed up postopera- tively for eight months, without any evidence of disease to date.
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Keywords

Endometriosis, Abdominal wall, Cell transformation, neoplastic, Adenocarcinoma, clear cellAbstract

Background

Malignant transformation of endometriosis in the abdominal wall is a rare and still poorly understood event. Less than 30 cases have been reported in the worldwide literature. Most cases of solid tumors are report in a previous abdominal scar with malignant transformation of a focus of endometriosis. Presence of lymph node metastases in nearby chains is frequent and is associated with poor prognosis. CASE REPORT: We report a case of a 42-year-old woman with a history of abdominal surgery (Pfannen- stiel) to resect abdominal wall endometriosis. Physical examination revealed a solid mass of approximately 10 cm x 6 cm in the anterior wall of the abdomen. Computed tomography (CT) of the abdomen and pel- vis showed a heterogeneous, predominantly hypoattenuating expansive formation measuring 10.6 cm x 4.7 cm x 8.3 cm. The patient underwent exploratory incisional laparotomy, block resection of the abdomi- nal mass and lymphadenectomy of the external and inguinal iliac chains. The abdominal wall was recon- structed using a semi-absorbable tissue-separating screen to reconstitute the defect caused by resection of the tumor. Histological evaluation revealed infiltration by malignant epithelioid neoplasia, thus confirm- ing the immunohistochemical profile of adenocarcinoma with clear cell components. Lymphadenectomy showed metastatic involvement of an external iliac chain lymph node. CONCLUSION: Resection of the mass along with the abdominal wall, with wall margins, is the most effec- tive treatment. Reconstruction is a challenge for surgeons. The patient has been followed up postopera- tively for eight months, without any evidence of disease to date. Downloads

References

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