Malignant Transformation Associated with Endometrioid Adenocarcinoma: A Rare Case Report and Review
Introduction:
Endometriosis, a benign condition affecting approximately 176 million women worldwide, can sometimes exhibit characteristics reminiscent of malignant tumors. A small percentage of endometriosis patients are at risk of malignancy, with a rare complication being the malignant transformation of abdominal wall endometriosis (AWE). This case report aims to present a rare instance of secondary AWE following a cesarean section, which progressed into endometrioid adenocarcinoma. We also review the literature to provide a comprehensive understanding of this uncommon entity.
Case Presentation:
A 39-year-old female presented with a progressive abdominal mass, discovered over 4 months. Her medical history included a left lung teratoma and a cesarean section. Physical examination revealed a cesarean section scar and a palpable mass in the left lower abdominal wall. Imaging studies, including ultrasound and CT scans, suggested a cystic-solid mass. Tumor markers were elevated, but not indicative of malignant transformation. The patient underwent laparoscopic exploration, abdominal wall mass resection, and plastic surgery. Postoperative pathology confirmed highly differentiated adenocarcinoma with squamous cell features, consistent with endometrioid carcinoma.
Discussion:
Malignant transformation of AWE is rare, with clear cell carcinoma being the most frequently reported type. Endometrioid adenocarcinoma, serous carcinoma, and mixed cancers are less common. The pathogenesis of endometriosis and its malignant transformation is complex, involving various theories such as retrograde menstruation and stem cell theory. Molecular studies suggest correlations between genetic mutations and the development of endometriosis and its associated malignancies, including PTEN and ARID1A gene mutations.
Clinical Manifestation and Auxiliary Examination:
AWE patients typically present with abdominal wall nodules or masses, often accompanied by pain. Ultrasound is the most commonly used imaging method due to its convenience and cost-effectiveness. MRI and CT scans provide high-resolution images and assist in determining the presence of distant metastases. Tumor markers like CA125 are of limited value in diagnosing malignant transformation of AWE.
Pathological Features:
The predominant pathological pattern of endometriosis-associated ovarian carcinoma (EAOC) is endometrioid adenocarcinoma. However, clear cell carcinoma is the most frequently reported type of malignant transformation of AWE. Immunohistochemical staining combined with pathological features can improve the accuracy of diagnosing endometrioid adenocarcinoma.
Treatment and Post-Treatment Monitoring:
There is no consensus on the optimal surgical and postoperative approach. Wide resection, hysterectomy, bilateral adnexectomy, and inguinal lymph node dissection are common treatments. Adjuvant chemotherapy and radiotherapy may be administered in some cases. A study reported high recurrence rates within 2 years for malignant transformation of AWE.
Conclusion:
Preventive measures, such as reducing cesarean section rates and meticulous incision protection, are crucial. The assessment of abdominal wall masses requires integration of clinical and radiologic information, with biopsy and histopathology essential for confirmation. Surgical approaches should consider fertility preservation, and wide resection, hysterectomy, and lymph node dissection are recommended for confirmed cases.
Ethic Approval and Consent to Participate:
Written informed consent was obtained from the patient, and ethics committee approval was granted. As this was a case report, no identifying information was included.
Consent for Publication:
All authors consented to participate and publication of this work.
Acknowledgments:
We express gratitude to all contributors and supporters of this report.
Author Contributions:
All authors made significant contributions, whether in conception, study design, execution, data acquisition, analysis, interpretation, drafting, revising, or critically reviewing the article. They provided final approval of the version to be published and agreed to be accountable for all aspects of the work.
Funding:
This work was supported by various grants to Ming Wei and Xingzhou Zhang.
Disclosure:
The authors declare no competing interests.
