Malignant transformation of caesarean scar endometriosis– presentation of three case reports and review of the literature

Endometriosis (EN) is a very common disease affecting about 5-10% women in reproductive age. Besides ovaries and peritoneum, the abdominal wall is one of the most common localizations of endometrial implants. The occurrence of EN in these cases is associated with previous gynecological surgeries, especially with cesarean section, and is usually a benign condition. Malignant transformation of endometrial foci is very rare and in most cases it accompanies the ovarian EN. In this paper the authors present three cases of malignant transformation of cesarean scar EN: two into clear cell carcinoma, and one into peritoneal adenocarcinoma of Müllerian type (PAMT), which is the first described case of this type of EN-originated tumor.

Endometriosis; Malignant transformation; Clear cell carcinoma.

[1] Heaps J.M., Nieberg R.K., Berek J.S.: ”Malignant neoplasms arising in endometriosis”. Obstet. Gynecol., 1990, 75, 1023.

[2] Bats A.S., Zafrani Y., Pautier P., Duvillard P., Morice P.: ”Malignant transformation of abdominal wall endometriosis to clear cell carcinoma: case report and review of the literature”. Fertil. Steril., 2008, 90, 1197.

[3] Sampson J.A.: ”Endometrial carcinoma of the ovary, arising in endometrial tissue in that organ”. Arch. Surg., 1925, 10, 1.

[4] Scott R.B.: ”Malignant change in endometriosis”. Obstet. Gynecol., 1953, 2, 283.

[5] Madsen H., Hansen P., Andersen O.P.:” Endometrioid carcinoma in an operation scar”. Acta. Obstet. Gynecol. Scand., 1980, 59, 475.

[6] Schnieber D., Wagner-Kolb D.: ”Malignant degeneration of an extragenital endometriosis”. Geburtshilfe und Frauenheilkunde., 1986, 46, 658.

[7] Hitti I.F., Glasberg S.S., Lubicz S.: ”Clear cell carcinoma arising in extraovarian endometriosis: report of three cases and review of the literature”. Gynecol. Oncol., 1990, 39, 314.

[8] Markopoulos C., Gogas H., Eleftheriou G., Floros D.: ”Endometrioid carcinoma arising in a scar of caesarean section. Case report”. Eur. J. Gynecol. Oncol., 1996, 17, 520.

[9] Gucer F., Reich O., Kometter R., Pieber D.: ”Endometrioid carcinoma arising with a scar endometriosis”. Eur. J. Gynecol. Oncol., 1997, 18, 42.

[10] Miller D.M., Schools J.J., Ehlen T.G.: “Clear cell carcinoma arising in extra-gonadal endometriosis in a caesarean section scar during pregnancy”. Gynecol. Oncol., 1998, 70, 127.

[11] Park S.W., Hong S.M, Wu H.G., Ha S.W.: “Clear cell carcinoma arising in a caesarean section scar endometriosis: a case report”. J. Korean. Med. Sci., 1999, 14, 217.

[12] Ishida G.M., Motoyama T., Watanabe T., Emura I.: “Clear cell carcinoma arising in a caesarean section scar. Report of a case with fine needle aspiration cytology”. Acta. Cytol., 2003, 47, 1095.

[13] Li J.Y., Chen Y.J., Wu Y.C., Hung J.H., Yuan C.C., Shu L.P., Wang PH.: “Two- and three- dimensional Doppler ultrasound analysis of abdominal wall clear cell carcinoma”. Ultrasound Obstet. Gynecol., 2003, 22, 98.

[14] Matter M., Schneider N., McKnee T.: ”Cystadenocarcinoma of the abdominal wall following caesarean section: case report and review of the literature”. Gynecol. Oncol., 2003, 91, 438.

[15] Olejek A., Bichalski W., Rembielak-StaweckaB., Ziolkowski A.: ”Adenocarcinoma arising from endometriosis in scar from cesarean section treated with the use of plastic mesh”. Ginekol. Pol., 2004, 75, 797.

[16] Leng J., Lang J., Guo L., Li H., Liu Z.: “Carcinosarcoma arising from atypical endometriosis in a cesarean section scar”. Int. J. Gynecol. Cancer, 2006, 16, 432.

[17] Alberto V.O., Lunch M., Labbei F.N., Jeffers M.: “Primary abdominal wall clear cell carcinoma arising in a cesarean section scar endometriosis”. Ir. J. Med. Sci., 2006, 175, 69.

[18] Sergent F., Baron M., Le Cornec J.B., Scotte M., Mace P., MarpeauL.: “Malignant transformation of abdominal wall endometriosis: a new case report”. J. Gynecol. Obstet. Biol. Reprod., 2006, 35, 186.

[19] Harry V.N., Shanbhag S., Lyall M., Narayansingh G.V., Parkin D.E.: “Isolated clear cell adenocarcinoma in scar endometriosis mimicking an incisional hernia”. Obstet. Gynecol., 2007, 110, 469.

[20] Razzouk K., Roman H., Chanavas-Lacheray I., Scotte M., Verspyck E., Marpeau L.: “Mixed clear cell and endometrioid carcinoma arising in parietal endometriosis”. Gynecol. Obstet. Invest., 2007, 63, 140.

[21] Rust M.M., Susa J., Naylor R., Cavuoti D.: “Clear cell carcinoma in a background of endometriosis. Case report of a finding in a midline abdominal scar 5 years after a total abdominal hysterectomy”. Acta. Cytol., 2008, 52, 475.

[22] Achach T., Rammech S., Trabelsi A., Ltaief R., Abdelkrim S.B., Mokni M., Korbi S.: “Clear cell adenocarcinoma arising from abdominal wall endometriosis”. J. Oncol., 2008, 2008, 478325.

[23] Williams C., Petignat P., Belisle A., Drouin P.: “Primary abdominal wall clear cell carcinoma: case report and review of the literature”. Anticancer. Res., 2009, 29, 1591.

[24] Matsuo K., Alonsozana E.L.C., Eno M.L. et al.: “Primary peritoneal clear cell adenocarcinoma arising in previous abdominal scar for endometriosis surgery”. Arch. Gynecol. Obstet., 2009, 280, 637.

[25] Omranipour R., Najafi M.: “Papillary serous carcinoma arising in abdominal wall endometriosis treated with neoadjuvant chemotherapy and surgery”. Fertil. Steril., 2010, 93, 1347.

[26] Bourdel N., Durand M., Gimbergues P., Dauplat J., Canis M.: “Exclusive nodal recurrence after treatment of degenerated parietal endometriosis”. Fertil. Steril., 2010, 93, 2074.

[27] Drukała Z., Ciborowska-Zielińska B., KubrakJ., Rogowska D.: “Outcome of multimodal therapy of a recurrent adenocarcinoma arising from caesarean section scar endometriosis- a case report”. Rep. Prac. Oncol. Radiother., 2010, 15, 75.

[28] Da Ines D., Bourdel N., Charpy C., Montoriol P.F., Petitcolin V., Canis M., Garcier J.M.: “Mixed endometrioid and serous carcinoma developing in abdominal wall endometriosis following cesarean section”. Acta. Radiol., 2011, 52, 587.

[29] Shalin S.C., Haws A.L., Carter D.G., Zarrin-Khameh N.,: “Clear cell adenocarcinoma arising from endometriosis in abdominal wall cesarean section scar: a case report and review of the literature”. J. Cutan. Pathol., 2012, 39, 1035.

[30] Mert I., Semaan S., Kim S., Ali-Fehmi R., Morris T.: “Clear cell carcinoma arising in the abdominal wall: two case reports and literature review”. American. J. Obstet. Gynecol., 2012, 207, 7.

[31] Li X., Yang J., Cao D., Lang J., Chen J., Shen K.: “Clear cell carcinoma of the abdominal wall after cesarean delivery”. Obstet. Gynecol., 2012, 120, 445.

[32] Ijichi S., Mori T., Suganuma I., Yamamoto T., Matsushima H., Ito F. et al.: “Clear cell carcinoma arising from cesarean section scar endometriosis: case report and review of the literature”. Case. Rep. Obstet. Gynecol., 2014, 103, 1.

[33] Spinelli C., Strambi S., Tartaglia D., Di Franco G., Pucii V., Faviana P., Lencioni M.: “Primary retroperitoneal Mullerian adenocarcinoma: a case report and literature review”. Case. Rep. Oncol., 2013, 6, 616.

[34] Williams K.J., Hayes A.J.: “A guide to oncological management of soft tissue tumors of the abdominal wall”. Hernia, 2014, 18, 91.