Clear Cell Adenocarcinoma Arising from Endometriosis in Abdominal Wall Cesarean Section Scar: A Case Report and Literature Review

Abstract

Background Endometriosis developing in a cesarean section (CS) scar is an unusual event. Malignant transformation arising on the background of scar endometriosis in the abdominal wall is extremely rare. Herein we report a case of clear cell carcinoma (CCC) arising in the abdominal wall from endometriosis tissues following CS and review previous literature. Case Presentation A 48-year-old gravida 2 para 1 female presented with an abdominal wall mass at her CS scar, which increased in size and became painful in the last 2 years. Physical examination showed a multilocular solid mass of about 13 cm, at the previous CS scar. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 12.8cm × 7.7cm multi-septate cystic lesion on the anterior abdominal wall, and histological examination showed that CCC was caused by the transformation of abdominal wall endometriosis (AWE). Conclusion An endometriosis-associated malignancy should be considered in the differential with any enlarging mass in the abdominal wall scar.

Abdominal wall endometrioma after Cesarean section: a case series

“…This condition may be more common than previously thought and accounted for in literature [ 1 ]. Prompt diagnosis is crucial to prevent delay in treatment as malignant transformation into endometrioid carcinoma, sarcoma, or clear cell adenocarcinoma has been reported [ 16 , 17 ]. A review of 12 cases of AWE demonstrated transformation to clear cell adenocarcinoma with an average age of diagnosis at 45.7 years with a high associated mortality of 25% within 15 months of diagnosis [ 17 ].…”

“…Additionally, malignant transformation of AWE after Cesarean section has recently increased. Proposed thoughts for this trend are due to a general increase in the number of Cesarean sections from 7% in 1990 to 21% in the present day [ 16 , 18 ]. As a result, the possibility of malignancy should be strongly considered in patients who present with Esquivel’s triad [ 16 ].…”

“…Recurrence is also an important factor to consider during resection. The recurrence rate for AWE ranges from 4.3% to 11% with 5.2 years as the mean time to recurrence after excision [ 16 , 19 ]. Thus, thorough excision margins intraoperatively can confer benefits to the patient and decrease rates of recurrence: 1-cm margins have been shown to decrease the risk of recurrence.…”