Clear cell carcinoma arising from abdominal wall endometriosis with lymph node metastasis – a rare case report and review of the literature

Abdominal wall endometriosis represents 1-2% of all endometriotic lesions. The malignant transformation of abdominal wall en-dometriosis is rare, though it can occur. Herein the authors report a rare case of clear cell adenocarcinoma arising from abdominal wall endometriosis with extensive lymph node metastasis. In this case, a 51-year-old woman presented with a growing mass in the right periumbilical area. Computed tomography scan revealed a 5-cm solid mass located on the right rectus muscle. A punch biopsy of the abdominal lesion was performed and histology showed metastatic adenocarcinoma of unknown origin. She had a surgical history of la-paroscopic subtotal hysterectomy with right salpingo-oophorectomy. The patient underwent radical excision of the mass, trachelectomy, left salpingo-oophorectomy, and lymph node dissection. The abdominal wall mass showed clear cell adenocarcinoma arising from en-dometriosis on histology. There were extensive lymph node metastases. The patient underwent adjuvant chemotherapy. Both lymphatic and local invasion are key routes of clear cell adenocarcinoma arising from abdominal wall endometriosis. Extensive lymph node metas-tasis could be associated with poor prognosis.

Clear cell carcinoma; Endometriosis; Lymph node; Metastasis.

[1] Johnson N.P., Hummelshoj L.: “World Endometriosis Society Mont-pellier C: Consensus on current management of endometriosis”. Hum. Reprod., 2013, 28, 1552.

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

[3] Horton J.D., Dezee K.J., Ahnfeldt E.P., Wagner M.: “Abdominal wall endometriosis: a surgeon’s perspective and review of 445 cases”. Am. J.Surg., 2008, 196, 207.

[4] Kurman R.J., Shih Ie M.: “Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer—shifting the paradigm”. Hum. Pathol., 2011, 42, 918.

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

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

[7] Victory R., Diamond M.P., Johns D.A.: “Villar’s nodule: a case re-port and systematic literature review of endometriosis externa of the umbilicus”. J. Minim. Invasive Gynecol. 2007, 14, 23.

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

[9] 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 sec-tion”. Acta Radiol., 2011, 52, 587.

[10] Liu H., Leng J., Lang J., Cui Q.: “Clear cell carcinoma arising from abdominal wall endometriosis: a unique case with bladder and lymph node metastasis”. World J. Surg. Oncol., 2014, 12, 51.

[11] Scott R.B.: “Malignant changes in endometriosis”. Obstet. Gynecol., 1953, 2, 283.

[12] 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.

[13] Yan Y., Li L., Guo J., Zheng Y., Liu Q.: “Malignant transformation of an endometriotic lesion derived from an abdominal wall scar”. Int. J. Gynaecol. Obstet., 2011, 115, 202.

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

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

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