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Clear cell carcinoma arising from cesarean section scar endometriosis: case report and review of the literature.

Ijichi S, Mori T, Suganuma I, Yamamoto T, Matsushima H, Ito F, Akiyama M, Kusuki I, Kitawaki J - Case Rep Obstet Gynecol (2014)

Bottom Line: Discussion.No malignant lesions were observed in either the uterus or adnexa that were resected.The significance of the extensional resection should be further elucidated.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.

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.

No MeSH data available.


Related in: MedlinePlus

(a) Smooth mass on the middle-left side of the cesarean median scar. (b) Pelvic MRI (T2 weighted image, axial section). MRI shows the tumor associated with cesarean section scar. The right side of the scar consists of solid components and the tumor at the left side of the scar is polycystic.
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fig1: (a) Smooth mass on the middle-left side of the cesarean median scar. (b) Pelvic MRI (T2 weighted image, axial section). MRI shows the tumor associated with cesarean section scar. The right side of the scar consists of solid components and the tumor at the left side of the scar is polycystic.

Mentions: The patient noticed the nodule near the abdominal operation scar with no tenderness 4 years before presentation. The nodule grew quickly in size with no significant pain, even during menstruation. Physical examination revealed a smooth mass measuring 4 cm in diameter on the middle-left side of the cesarean median scar (Figure 1(a)). A biopsy of the mass showed atypical cells, and subsequent pelvic magnetic resonance imaging (MRI) showed two lesions, measuring 2.5 × 3.3 cm and 3.3 × 4.0 cm along the abdominal scar (Figure 2(b)). The mass located at the right side of the scar consisted of solid components, while that on the left was polycystic. There were no obvious mass-like lesions in the intraperitoneal cavity or any of the abdominal or pelvic lymph nodes. Laboratory tests revealed no increase in the serum levels of tumor markers (CEA, CA19-9, and CA125). Radical resection of the abdominal wall mass was performed with adequate margins under general anesthesia. Histopathological examination showed clear cell adenocarcinoma (Figure 2(a)), suggesting malignant transformation from endometriosis of the abdominal wall. Positron emission tomography (PET) showed no evidence of malignancy, including in the uterus, bilateral ovaries, and pelvic lymph nodes. Considering these findings together, we diagnosed clear cell adenocarcinoma of the abdominal wall arising from endometriosis after cesarean section. Eight months after the resection, a nodular lesion appeared in the patient's abdominal scar again. MRI and PET scan showed local recurrence, and she was hospitalized for resection of the recurring tumor and abdominal wall reconstruction. Histopathological examination showed the lesion to be clear cell adenocarcinoma. At 15 months after the second operation, there was no further evidence of the disease on imaging studies or clinical examination.


Clear cell carcinoma arising from cesarean section scar endometriosis: case report and review of the literature.

Ijichi S, Mori T, Suganuma I, Yamamoto T, Matsushima H, Ito F, Akiyama M, Kusuki I, Kitawaki J - Case Rep Obstet Gynecol (2014)

(a) Smooth mass on the middle-left side of the cesarean median scar. (b) Pelvic MRI (T2 weighted image, axial section). MRI shows the tumor associated with cesarean section scar. The right side of the scar consists of solid components and the tumor at the left side of the scar is polycystic.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230015&req=5

fig1: (a) Smooth mass on the middle-left side of the cesarean median scar. (b) Pelvic MRI (T2 weighted image, axial section). MRI shows the tumor associated with cesarean section scar. The right side of the scar consists of solid components and the tumor at the left side of the scar is polycystic.
Mentions: The patient noticed the nodule near the abdominal operation scar with no tenderness 4 years before presentation. The nodule grew quickly in size with no significant pain, even during menstruation. Physical examination revealed a smooth mass measuring 4 cm in diameter on the middle-left side of the cesarean median scar (Figure 1(a)). A biopsy of the mass showed atypical cells, and subsequent pelvic magnetic resonance imaging (MRI) showed two lesions, measuring 2.5 × 3.3 cm and 3.3 × 4.0 cm along the abdominal scar (Figure 2(b)). The mass located at the right side of the scar consisted of solid components, while that on the left was polycystic. There were no obvious mass-like lesions in the intraperitoneal cavity or any of the abdominal or pelvic lymph nodes. Laboratory tests revealed no increase in the serum levels of tumor markers (CEA, CA19-9, and CA125). Radical resection of the abdominal wall mass was performed with adequate margins under general anesthesia. Histopathological examination showed clear cell adenocarcinoma (Figure 2(a)), suggesting malignant transformation from endometriosis of the abdominal wall. Positron emission tomography (PET) showed no evidence of malignancy, including in the uterus, bilateral ovaries, and pelvic lymph nodes. Considering these findings together, we diagnosed clear cell adenocarcinoma of the abdominal wall arising from endometriosis after cesarean section. Eight months after the resection, a nodular lesion appeared in the patient's abdominal scar again. MRI and PET scan showed local recurrence, and she was hospitalized for resection of the recurring tumor and abdominal wall reconstruction. Histopathological examination showed the lesion to be clear cell adenocarcinoma. At 15 months after the second operation, there was no further evidence of the disease on imaging studies or clinical examination.

Bottom Line: Discussion.No malignant lesions were observed in either the uterus or adnexa that were resected.The significance of the extensional resection should be further elucidated.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.

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.

No MeSH data available.


Related in: MedlinePlus