A Rare Case of Combined Endometrioid Adenocarcinoma Arising from Uterine Adenomyosis and Clear Cell Carcinoma Arising from Parametrial Deep Endometriosis

Abstract

Background: Simultaneously malignant transformation from both uterine adenomyoma and deep endometriotic lesions is very rare. Case presentation: We present a case of a 44-year-old nulliparous woman begun with abdominal pain and intestinal obstruction. Past medical history showed laparoscopic ovarian endometriotic cyst excision. Ultrasound indicated adenomyoma and a parametrial hypoechoic nodule with abundant blood flow signals and unclear boundaries. Deep invasive endometriosis was considered preoperatively. The patient underwent laparoscopic subextensive hysterectomy and bilateral adnexa resection. Chocolate cyst-like lesion was observed in the parametiral lesion. Postoperative pathological examinations suggested endometrioid adenocarcinoma arising from eutopic endometrium and adenomyoma. Left parametrial lesions suggested poorly differentiated endometrioid adenocarcinoma combined with clear cell carcinoma. CD10+ endometrial stromal cells was observed surrounding tumor cell masses. The patient underwent subsequent transabdominal tumor cell reduction surgery and chemotherapy.Conclusion: Combined with surgical founding and pathological characters of the left parametrial adenocarcinoma, it was more likely to be carcinomatous changes of the original deep endometriosis.