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

Abstract

BACKGROUND: 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 (Pfannenstiel) 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 pelvis 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 abdominal mass and lymphadenectomy of the external and inguinal iliac chains. The abdominal wall was reconstructed 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 confirming 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 effective treatment. Reconstruction is a challenge for surgeons. The patient has been followed up postoperatively for eight months, without any evidence of disease to date. I MD. Resident Physician,

Genes’ Interactions: A Major Contributor to the Malignant Transformation of Endometriosis

“…The development of different types of endometrial cells during the transportation of endometrium has been reported in other cases as well. For example, it has been reported the malignant transformation of endometriosis to neoplasia in the abdominal wall with an immunohistochemical profile of adenocarcinoma with clear cell components [15]. In this case, metastasis to an external iliac chain lymph node was also observed during lymphadenectomy.…”

“…Recent studies have used epidemiological data to identify the principles of endometriosis’ transformation. In a recent large cohort study, the increased risk for the development of ovarian cancer (OC) to women with surgical diagnosis of endometriosis was confirmed [15]. It is worth mentioning here that cohort studies have shown that EAOCs have an early diagnosis and an improved rate of patients’ survival [16,17,18,19,20,21,22].…”

A case of ileus caused by ileal endometriosis with lymph node involvement

“…Furthermore, intestinal obstruction associated with endometriosis is rare, occurring in only 23% of all cases with ileal involvement [4]. Lymph node involvement in endometriosis is usually considered to be uncommon [5]. We report our experience of a patient with endometriosis of the terminal ileum that was complicated by small bowel obstruction and lymph node involvement.…”

The risk of endometriosis-associated malignant transformation in a scar after cesarean section: a case report and a review of literature

“…Endometriosis was found in the tumor tissue in more than 66% of cases (6) . A history of endometriosis was confirmed in 20-50% of patients (7) , with at least one surgery due to endometriosis in about 10% of these patients (resection of a tumor from the postoperative scar in most cases) (6,8,9) . The mean time between detecting endometriotic foci and the diagnosis of endometriosis-associated abdominal wall cancer is 20 years, which indicates a slow process of neoplastic transformation (4) .…”

“…W ponad 66% przypadków tkance nowotworowej towarzyszyła obecność endometriozy (6) . Wcześniejsze występowanie endometriozy stwierdzono u 20-50% pacjentek (7) ; dodatkowo w tej grupie u około 10% chorych przeprowadzono przynajmniej jedną operację z powodu endometriozy -najczęściej było to usunięcie guzka z blizny pooperacyjnej (6,8,9) . Średni czas od stwierdzenia obecności ognisk endometriozy do rozpoznania raka powłok brzusznych na podłożu endometriozy wskazuje na powolny proces transformacji nowotworowej i wynosi około 20 lat (4) .…”