Clear Cell Carcinoma Arising from Cesarean Section Scar Endometriosis: Case Report and Review of the Literature

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.

Endometrioid adenocarcinoma arising from deep infiltrating endometriosis involving the bladder: A case report and review of the literature

“…This suggests that the interfusion of endometrium into the bladder may contribute to carcinogenesis. The histological types of malignant transformation in endometriosis involving the bladder are primarily clear cell carcinoma (5/9; 55.6%), followed by endometrioid adenocarcinoma (2/9; 22.2%), mixed histology (clear cell carcinoma and endometrioid adenocarcinoma) (1/9; 11.1%), and endometrioid adenosarcoma (1/9; 11.1%), which is comparable with malignant transformation of endometriosis arising from other sites including ovarian endometrioma and the abdominal wall ( Ijichi et al, 2014 ).…”

Transformation of Abdominal Wall Endometriosis to Clear Cell Carcinoma

“…The time frame to the diagnosis of clear cell carcinoma arising from endometriotic implants in anterior abdominal wall scars ranges from 9 to 35 years after a cesarean section. 19 cases have been reported to date (15 cases noted in reference article [ 5 ], 1 case reported by Bats et al 2008 [ 6 ], 1 case by Alberto et al [ 7 ], and 2 cases presented here). Patient ages have ranged from 38 to 60 years at diagnosis [ 5 ].…”

Endometriosis-associated malignant transformation in abdominal surgical scar

“…Eighteen patients needed at least 1 more surgery [ 12 , 24 , 26 , 27 , 29 – 31 , 33 – 35 , 38 , 39 , 41 , 43 , 45 , 46 , 48 , 49 ] while 4 patients needed more than 2 surgeries. [ 37 – 39 , 42 ]…”

“…Relapse of the disease was reported in 16 patients. [ 9 , 12 , 20 , 22 , 24 , 25 , 27 , 29 – 31 , 33 , 34 , 39 , 41 , 48 , 49 ] The recurrent sites were: local (4 cases), [ 29 , 31 , 48 , 49 ] lymphatic (7 cases, all inguinal), [ 12 , 27 , 30 , 33 , 34 , 39 , 41 ] and distant metastases – usually hepatic, [ 22 , 25 ] pulmonary, [ 9 , 20 , 22 , 24 ] brain, [ 17 ] and bone. [ 9 , 20 ]…”