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

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

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

Blanco RG, Parithivel VS, Shah AK, et al. Abdominal wall endometriomas. Am J Surg. 2003;185(6):596-8. Zhao X, Lang J, Leng J, et al. Abdominal wall endometriomas. Int J Gynaecol Obstet. 2005;90(3):218-22. Omranipour R, Najafi M. Papillary serous carcinoma arising in abdominal wall endometriosis treated with neoadjuvant chemotherapy and surgery. Fertil Steril. 2010;93(4):1347.e17-8. 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(11):1035-41. Sampson JA. Endometrial carcinoma of the ovary arising in endometrial tissue in that organ. American Journal of Obstetrics & Gynecology. 1925;9(1):111-4. Available from: http://www.ajog.org/article/S0002-9378(25)90949-0/abstract. Accessed in 2017 (Jul 14). Scott RB. Malignant changes in endometriosis. Obstet Gynecol. 1953;2(3):283-9. 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(4):1197.e13-6. Schineber D, Wagner-Kolb D. [Malignant transformation of extragenital endometriosis]. Geburtshilfe Frauenheilkd. 1986;46(9):658-9. Hitti IF, Glasbergg SS, Lubicz S. Clear cell carcinoma arising in extraovarian endometriosis: report of three cases and review of the literature. Gynecol Oncol. 1990;39(3):314-20. Miller DM, Schouls JJ, Ehlen TG. Clear cell carcinoma arising in extragonadal endometriosis in a caesarean section scar during pregnancy. Gynecol Oncol. 1998;70(1):127-30. Park SW, Hong SM, Wu HG, Ha SW. Clear cell carcinoma arising in a Cesarean section scar endometriosis: a case report. J Korean Med Sci. 1999;14(2):217-9. Ishida GM, Motoyama T, Watanabe T, Emura I. Clear cell carcinoma arising in a cesarean section scar. Report of a case with fine needle aspiration cytology. Acta Cytol. 2003;47(6):1095-8. Sergent F, Baron M, Le Cornec JB, et al. Malignant transformation of abdominal wall endometriosis: a new case report]. J Gynecol Obstet Biol Reprod (Paris). 2006;35(2):186-90. Alberto VO, Lynch M, Labbei FN, Jeffers M. Primary abdominal wall clear cell carcinoma arising in a Caesarean section scar endometriosis. Ir J Med Sci. 2006;175(1):69-71. Rust MM, Susa J, Naylor R, Cavuoti D. Clear cell carcinoma in a background of endometriosis. Case report of a finding in a midline abdominal scar 5 years after a total abdominal hysterectomy. Acta Cytol. 2008;52(4):475-80. Razzouk K, Roman H, Chanavaz-Lacheray I, et al. Mixed clear cell and endometrioid carcinoma arising in parietal endometriosis. Gynecol Obstet Invest. 2007;63(3):140-2. Williams C, Petignat P, Belisle A, Drouin P. Primary abdominal wall clear cell carcinoma: case report and review of literature. Anticancer Res. 2009;29(5):1591-3. 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(2):202-3. Mert I, Semaan A, Kim S, Ali-Fehmi R, Morris RT. Clear cell carcinoma arising in the abdominal wall: two case reports and literature review. Am J Obstet Gynecol. 2012;207(2):e7-9. Markopoulos C, Gogas H, Eleftheriou G, Floros D. Endometrioid carcinoma arising in a scar of caesarean section. Case report. Eur J Gynaecol Oncol. 1996;17(6):520-1. Gücer F, Reich O, Kömetter R, Pieber D. Endometroid carcinoma arising with a scar endometriosis. Eur J Gynaecol Oncol. 1997;18(1):42-3.