Clear cell degeneration associated with endometriosis of abdominal wall after cesarean section: A case report and systematic review of literature

Abstract

Aim The scar of cesarean section (CS) is the most common site of abdominal wall endometriosis (AWE), whose tumor degeneration has been reported in an increasing number of cases; the most frequent histological type is clear cell carcinoma (CCC). Methods We conducted a systematic research of the literature, collecting data regarding the evidence on tumor degeneration from AWE after CS. Moreover, we reported a case of clear cell borderline tumor (CCBT) originating from AWE. Results We included data of 37 patients with diagnosis of CCC. The average time between the last CS and the diagnosis of CCC was around 15 years. Overall, 26.0% and 73.9% patients received exclusive local abdominal resection of the lesion and additional surgery, respectively. Lymph nodes involvement was detected in 26.0 % patients and adjuvant chemotherapy was administered in 52.0 % cases. During follow‐up period, 15.2% patients died of disease, 32.6% had no evidence of disease, and 17.4% recurred. We diagnosed a CCBT arose in a patients with AWE and a personal history of several surgical procedures for endometriosis, a CS and a subsequent transverse laparotomy. We performed an open bilateral ovariectomy and a large excision of the endometriotic abdominal lesion. Conclusion Tumor degeneration from AWE seems to be a real occurrence with an increasing number of events. Considering the lack of risk factors and diagnostic instruments for tumor degeneration, the removal of AWE localization could be advisable, even though there was long average time between the trigger surgery and the tumor finding.

An exceptional case of degenerative endometriosis of the uterine torus

“…However, in this study, the risk of ovarian cancer is not increased in case of peritoneal or DIE. Ferrari et al 14 reported a case of clear cell carcinoma in a parietal endometriosis lesion (post-cesarean section and transverse laparotomy), while Chen et al 15 reported two cases of high-grade serous cancer (HGSC) in an endometriosis of the utero-sacral ligament, followed by Johnson et al 16 and Song et al, 17 each of whom reported a case of HGSC from in a rectal endometriosis. If we add the cases of cervical and rectal degeneration associated with Lynch syndrome, 18 and vaginal degeneration associated with endometrial cancer, 19,20 there are less than 10 cases of degeneration described in the literature (Table 1).…”

Clear cell carcinoma of the abdominal wall: A case report with a review of the literature

“…In a review of 6 cases, the mean time from the most recent pelvic surgery to diagnosis of clear cell carcinoma of abdominal wall was 20.2 years (18). There is no specific marker for malignant transformation and radiological findings are not helpful in distinguishing abdominal wall endometriosis from its degeneration [ 11 , 19 ]. As a result, lesions usually reach large size at the time of diagnosis with an average diameter of 11 cm [ 3 ].…”

“…Patients are primarily treated with wide tumor resection to obtain healthy margins combined with total hysterectomy and bilateral salpingo-oophorectomy [ 7 , 11 , 22 ]. Bilateral pelvic and inguinal lymph node dissection along with infracolic omentectomy may also be performed [ 18 ] in addition to adjuvant chemotherapy and radiotherapy [ 3 , 11 , 18 , 19 , 22 ].…”

Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review

“…Locally advanced cancer at the time of diagnosis can explain the poor prognosis of malignant AWE [17]. Some authors describe other prognostic factors such as the size of the mass at the time of diagnosis, which could play a role in a better outcome, especially if the masses range between 4 and 9 cm [63][64][65][66][67][68][69][70][71][72][73][74].…”