Malignant transformation of an endometriotic lesion derived from an abdominal wall scar

Abstract

In 2008, a 41-year-old woman who had undergone 2 cesarean deliveries presented at Daping Hospital, Chongqing, China, with a painful mass in her abdominal wall.A year before presentation, the woman underwent simultaneous panhysterectomy without bilateral adnexectomy and excision of an endometriotic lesion from the abdominal wall. Her pathology report indicated endometriosis in the subcutaneous tissue of the abdomen, fibromyoma uteri, and adenomyosis. Four months before the current presentation, a mass similar to the excised lesion developed in her abdominal wall, and she often experienced gas pain. The mass gradually grew and was diagnosed as a recurrent endometriotic lesion. She underwent gestrinone treatment-under the supervision of a physician-for 1 month; however, the mass continued to grow.Physical examination on hospitalization revealed a 90-mm mass in the scar in her hypogastrium. The mass had a clear boundary, slightly soft quality, no accompanying tenderness, and appeared partially violet in color. Gynecologic examination revealed no positive physical sign. Her height, weight, and body mass index (calculated as weight in kilograms divided by the square of height in meters) were 160 cm, 60 kg, and 23.4, respectively. Investigation via 64-slice computed tomography revealed a mass measuring 44.5 × 63.3 × 53.2 mm in the left lower abdominal wall; the mass was located between the muscle and the adipose layer (Fig. 1). The boundary between the mass and the surrounding tissue was not sufficiently clear. A suprapubic abdominal ultrasound scan showed no positive sign. The level of serum cancer antigen (CA)-125 was 6.3 U/mL.The woman subsequently underwent resection of the mass, which was approximately 100 mm in size and located in the subcutaneous tissue of the abdomen; the boundary between the mass and the normal tissue was obscure. Part of the mass consisted of several capsule-like structures containing a coffee-colored and chocolate-like fluid, and the rest was solid tissue similar to endometrium. The whole mass was resected. Owing to the patient's history of 3 surgeries in the pelvic cavity and a lack of data indicating any changes in her adnexa, pelvic operation was not performed.Light microscope examination of the solid tumor revealed a few glandular arrangements of globular or polygonal cells containing numerous vacuoles in the cytoplasm and hyperchromatic nuclei Fig. 1. Computed tomography (CT) of the abdomen showing a spherical, partly lobulated tumor in the abdominal wall of the hypogastrium. A. Transverse plane. B. Sagittal plane. A 64-slice CT (LightSpeed 64-slice VCT; General Electric, Fairfield, CT, USA) of the entire abdomen was performed at 120 kV and 80 mA (pitch, 0.625; reconstruction thickness, 8 mm; total scan time, 10.7 seconds). 202BRIEF COMMUNICATIONS

Endometriosis-associated clear cell carcinoma arising in caesarean section scar: a case report and review of the literature

“…However, it has to be considered that four patients had referred cyclic pain in the CS scar during menses, or the cyclic increase/decrease of the mass volume, which could be highly suggestive of the presence of endometriosis implants [14, 17, 19, 23]. Moreover, previous history of the excision of benign endometriosis foci at the CS scar was reported in five cases [9, 11, 13, 15, 16]. Therefore, the absence of pathologically assessed endometriosis foci could be interpreted as either a sampling problem or a consequence of the complete replacement of normal tissue due to massive neoplastic proliferation.…”

Reliable clinical and sonographic findings in the diagnosis of abdominal wall endometriosis near cesarean section scar

“…In addition, although the malignant transformation of abdominal wall endometrioma has not been clearly elucidated, owing to its rarity, such an eventuality should always be considered [24,25] ; therefore early detection and prompt treatment are mandatory.…”

Lesiones ocupantes de espacio en pared abdominal (no herniaria). La visión del patólogo

“…Las células neoplásicas expresan marcadores epiteliales (citoqueratinas, EMA) y musculares (actina de músculo liso), y hasta el 50 % de estas neoplasias muestran reordenamiento en el gen EWSR1. El diagnóstico diferencial se debe realizar con metástasis por adenocarcinoma en pared abdominal, condrosarcoma mixoide y sarcoma epitelioide [12][13][14][36][37][38][39][40][41][42][43] .…”

“…Aparecen frecuentemente en hombres de entre 40 y 70 años de edad como una masa supravesical en la línea media 12,13,[36][37][38][39][40][41][42][43] . El adenocarcinoma es el tipo histológico más común (90 %), y su variante entérica/mucinosa es la más frecuente.…”