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Harris CM, Singleton MP, Samulski T, Clark LH. Primary peritoneal clear cell carcinoma arising in the setting of abdominal wall Endometriosis: A case report and review of the literature. Gynecol Oncol Rep 2024; 53:101370. [PMID: 38590931 PMCID: PMC10999830 DOI: 10.1016/j.gore.2024.101370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/10/2024] Open
Abstract
•Primary peritoneal clear cell carcinoma can arise from endometriotic implants within the abdomen and pelvis.•Immunohistochemistry can be used to confirm primary disease site. Endometriotic origin can be inferred based on clinical history and intraoperative findings suggestive of endometriosis.•While no standardized treatment exists, consideration should be given to cytoreductive surgery with adjuvant chemotherapy. Adjuvant radiation can also be considered for local control.
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Affiliation(s)
- Cameron M. Harris
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Miller P. Singleton
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Theresa Samulski
- Department of Pathology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Leslie H. Clark
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
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2
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Alaert J, Lancelle M, Timmermans M, Tanos P, Nisolle M, Karampelas S. Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review. J Clin Med 2024; 13:2282. [PMID: 38673556 PMCID: PMC11050881 DOI: 10.3390/jcm13082282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Malignant-associated abdominal wall endometriosis (AWE) is a rare pathology, likely to occur in 1% of scar endometriosis. The objectives of this study were to update the evidence on tumor degeneration arising from AWE to notify about the clinical characteristics, the different treatments offered to patients and their outcomes. Methods: A comprehensive systematic review of the literature was conducted. PubMed, Embase and Cochrane Library databases were used. Prospero (ID number: CRD42024505274). Results: Out of the 152 studies identified, 63 were included, which involved 73 patients. The main signs and symptoms were a palpable abdominal mass (85.2%) and cyclic pelvic pain (60.6%). The size of the mass varied between 3 and 25 cm. Mean time interval from the first operation to onset of malignant transformation was 20 years. Most common cancerous histological types were clear cell and endometrioid subtypes. Most widely accepted treatment is the surgical resection of local lesions with wide margins combined with adjuvant chemotherapy. The prognosis for endometriosis-associated malignancy in abdominal wall scars is poor, with a five-year survival rate of around 40%. High rates of relapse have been reported. Conclusions: Endometrial implants in the abdominal wall should be considered as preventable complications of gynecological surgeries. Special attention should be paid to women with a history of cesarean section or uterine surgery.
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Affiliation(s)
- Julie Alaert
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium; (J.A.); (S.K.)
| | - Mathilde Lancelle
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Tivoli, Université Libre de Bruxelles, 7100 La Louviere, Belgium;
| | - Marie Timmermans
- Department of Obstetrics and Gynecology, CHU of Liege—Citadelle Site, University of Liège, 4000 Liege, Belgium; (M.T.); (M.N.)
| | - Panayiotis Tanos
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium; (J.A.); (S.K.)
| | - Michelle Nisolle
- Department of Obstetrics and Gynecology, CHU of Liege—Citadelle Site, University of Liège, 4000 Liege, Belgium; (M.T.); (M.N.)
| | - Stavros Karampelas
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, 1050 Brussels, Belgium; (J.A.); (S.K.)
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3
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Feng Z, Wen H, Ju X, Bi R, Chen X, Yang W, Wu X. Treatment for clear cell carcinoma of the abdominal wall at a tertiary cancer center. Sci Rep 2022; 12:10820. [PMID: 35752641 PMCID: PMC9233660 DOI: 10.1038/s41598-022-14917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/15/2022] [Indexed: 11/09/2022] Open
Abstract
Clear cell carcinoma (CCC) of the abdominal wall is a rare and agressive disease. We aim to elucidate the clinical and prognostic characteristics of this disease. Medical records of ten patients diagnosed with CCC of the abdominal wall at Fudan University Shanghai Cancer Center were reviewed. We illustrate the clinical characteristics, treatment modality, and development of local recurrence or distant metastasis, as well as the survival outcome. The median (range) age of patients was 47 (39-61) years old. All patients had a history of cesarean section and abdominal wall endometriosis. All patients had primary surgery before referred to our center. Seven patients had only tumor resection, while two patients had lymph node metastasis at primary diagnosis. Four patients underwent supplementary surgery, and all postoperative pathology were negative. Genetic analyses had also been performed. The median (range) follow-up time was 20 (12-59) months. Local recurrence and lymph node metastasis were the most common recurrence types. The median (95% confidence interval) PFS was 11 (8.08-13.92) months. In summary, primary surgery should consider wide tumor resection and lymph node dissection. Adjuvant chemotherapy and radiotherapy should be recommended for potential benefits. More cases are still needed to elucidate the clinical management of this disease.
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Affiliation(s)
- Zheng Feng
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Hao Wen
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xingzhu Ju
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Rui Bi
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Xiaojun Chen
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wentao Yang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Xiaohua Wu
- Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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4
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Liu G, Wang Y, Chen Y, Ren F. Malignant transformation of abdominal wall endometriosis: A systematic review of the epidemiology, diagnosis, treatment, and outcomes. Eur J Obstet Gynecol Reprod Biol 2021; 264:363-367. [PMID: 34391052 DOI: 10.1016/j.ejogrb.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/23/2021] [Accepted: 08/04/2021] [Indexed: 02/07/2023]
Abstract
Malignant transformation of abdominal wall endometriosis (AWE) is rare. The clinical characteristics and treatment of malignant transformation of AWE are not well known. Therefore, in this review, we performed a thorough search for malignant transformation of AWE on MEDLINE and Web of Science from their inception to May 2021. In total, the data of 46 patients with malignant transformation of AWE were retrieved, and all the data on these patients were collected. After reviewing and analyzing the clinical parameters, we found that cesarean scar was the most common site of malignant transformation of AWE, and the most common pathological type of malignant transformation of AWE was clear cell cancer, followed by endometrioid adenocarcinoma. The main symptoms of malignant transformation of AWE included an abdominal nodule or mass, and ultrasonography was the first choice for diagnosis. The most widely accepted treatment was surgical resection of local lesions with adjunctive chemotherapy and/or radiotherapy, and the overall survival of patients with malignant transformation of AWE was poor. In conclusion, malignant transformation of AWE is rare, and the prognosis is poor. Thus, improving abdominal surgical technology and avoiding iatrogenic ectopia and implantation of the endometrium are necessary to prevent malignant transformation of AWE.
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Affiliation(s)
- Gang Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Yizi Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Yinghan Chen
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China
| | - Fang Ren
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China.
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5
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Giannella L, Serri M, Maccaroni E, DI Giuseppe J, Carpini GD, Berardi R, Sopracordevole F, Ciavattini A. Endometriosis-associated Clear Cell Carcinoma of the Abdominal Wall After Caesarean Section: A Case Report and Review of the Literature. In Vivo 2021; 34:2147-2152. [PMID: 32606196 DOI: 10.21873/invivo.12021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM Clear cell carcinoma of the abdominal wall is a sporadic event. To date, about thirty cases have been reported in the literature. This article provides a case report and literature review of an infrequent occurrence with poor prognosis. CASE REPORT A 45-year-old woman with pelvic pain and an abdominal mass came to our attention. Her medical history was notable for two previous cesarean sections. Physical examination revealed a smooth, multilocular mass measuring about 20 cm, arising from the previous surgical scar. Histology revealed clear-cell carcinoma resulting from the transformation of abdominal wall endometriosis. Given the disease extent, the patient underwent front-line chemotherapy. After several and multiple chemotherapy regimens, there was a disease progression that resulted in the death of the patient in 7 months. The literature review showed that a previous cesarean section was present in 91% of cases. Besides, approximately 26.5% of women died within 12 months of being diagnosed. The mean age of women was 45.88 years, while the average size of the lesion was 11 cm. CONCLUSION Clear cell carcinoma is a rare but occurring event. Middle-aged women showing an abdominal wall mass in close relation with a surgical scar from a previous cesarean section must be promptly investigated. Treatment options usually include surgery and chemotherapy with poor results.
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Affiliation(s)
- Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Matteo Serri
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Elena Maccaroni
- Medical Oncology Unit, Polytechnic University of Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Jacopo DI Giuseppe
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Rossana Berardi
- Medical Oncology Unit, Polytechnic University of Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, CRO Centro di Riferimento Oncologico National Cancer Institute, Aviano, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
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6
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Hashemi SR, Morshedi M, Maghsoudi H, Esmailzadeh A, Alkatout I. Clear-cell carcinoma originating from cesarean section scar: two case reports. J Med Case Rep 2021; 15:146. [PMID: 33810809 PMCID: PMC8019170 DOI: 10.1186/s13256-021-02775-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/09/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Clear-cell carcinoma arising from the surgical cesarean section scar is very infrequent. The present study reports two patients with clear-cell carcinoma arising from an abdominal wall scar 20 and 23 years after their last cesarean section. CASE PRESENTATION Both Iranian patients had prior cesarean sections nearly 20 years earlier. Patients 1 and 2 had transverse and vertical abdominal incisions, respectively. The initial clinical presentation was a huge lower abdominal mass at the site of the previous cesarean section scar. Both patients underwent abdominal wall mass biopsy. The histological analysis revealed the presence of malignancy. Both patients underwent full-thickness resection of the abdominal wall mass. All surgical margins were tumor-free; however, patient 1 had a very narrow tumor-free margin near the pubic symphysis. As the imaging report of patient 2 revealed the presence of a pelvic mass, the exploration of the intraperitoneal space, simple total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and the excision of enlarged pelvic lymph nodes were performed during the surgery. Six cycles of paclitaxel and carboplatin every 3 weeks as adjuvant chemotherapy was administered for both patients after the surgery. One of the patients had disease recurrence 5 months after the termination of chemotherapy, and the other is still disease-free. These two patients had similar pathology and received a similar initial adjuvant treatment; however, they were different in terms of the direction of tumor spread, tumor distance from the pubic symphysis, status of tumor margins, and surgical procedures. CONCLUSIONS We encountered distinct prognoses in the clear-cell carcinoma of cesarean section scars presented herein. The researchers can recommend complete surgical excision of the abdominal wall mass with wide tumor-free margins, exploration of the abdominopelvic space, TAH, and BSO during the first surgery.
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Affiliation(s)
- Seyedeh Razieh Hashemi
- Department of Obstetrics and Gynecology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahdi Morshedi
- Department of Surgery, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Houshyar Maghsoudi
- Department of Radiology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Arezoo Esmailzadeh
- Department of Obstetrics and Gynecology, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ibrahim Alkatout
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel School of Gynaecological Endoscopy, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
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7
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Hasan A, Deyab A, Monazea K, Salem A, Futooh Z, Mostafa MA, Youssef A, Nasr M, Omar N, Rabaan AA, Taie DM. Clinico-pathological assessment of surgically removed abdominal wall endometriomas following cesarean section. Ann Med Surg (Lond) 2021; 62:219-224. [PMID: 33537134 PMCID: PMC7843362 DOI: 10.1016/j.amsu.2021.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Over the past few decades, the rate of Cesarean Section (CS) delivery has been rising rapidly and the prevalence of CS-associated complications including Abdominal Wall Endometriomas (AWE) increases with each additional operation. The aim of this study was to evaluate the clinical characteristics, histopathological diagnostic role and surgical management of post-CS AWE through a retrospective case review. METHODS We calculated the incidence of AWE and reviewed all the patients underwent surgical removal of Post-CS AWE during the period of 2012-2018 who were diagnosed, treated and followed up for 2-8 years at our tertiary hospital. RESULTS Thirty women with AWE were included. The main symptom in 2/3 of cases was cyclic pain and 4 cases (13.3%) had no symptoms. The mean interval between prior CS and appearance of symptoms was 55.2 months and the mean size of the excised mass was 42 mm. Free surgical margin was less than 9 mm in 9 patients (30%) but no recurrence was recorded among all the studied patients. Pre-operative FNAC diagnosis was performed for only 3 patients (10%) which helped in excluding other potential pathologies. The clinical-pathological agreement value for detection of the nature of the abdominal wall mass was 93.4%. CONCLUSIONS Patients with suspected AWE should undergo preoperative cytological biopsy to exclude alternative diagnosis. Wide surgical excision with margin of less than 1 cm could be accepted especially in case of weak abdominal wall. More studies on the post-CS complications; risks, prevention, early detection and proper management should be encouraged.
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Affiliation(s)
- Abdulkarim Hasan
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdou Deyab
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Khaled Monazea
- Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assiut Branch, Egypt
| | - Abdoh Salem
- Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Zahraa Futooh
- Department of General Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mahmoud A. Mostafa
- Department of Internal Medicine and Cardiology, King Fahad Hospital, Albaha, Saudi Arabia
| | - Ahmed Youssef
- Department of Surgical Oncology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Nasr
- Department of Histology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Nasser Omar
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali A. Rabaan
- Molecular Diagnostic Labortaory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Doha M. Taie
- Department of Pathology, National Liver Institute, Menoufia University, Shebin El Kom, Egypt
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8
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Ferrari F, Valenti G, Forte S, Ardighieri L, Iraci Sareri M, Barra F, Sartori E, Odicino F. Clear cell degeneration associated with endometriosis of abdominal wall after cesarean section: A case report and systematic review of literature. J Obstet Gynaecol Res 2021; 47:1243-1252. [PMID: 33442929 DOI: 10.1111/jog.14635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/11/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
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.
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Affiliation(s)
- Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili of Brescia, Brescia, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Gynecology, University of Catania, Catania, Italy
| | - Sara Forte
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Laura Ardighieri
- Department of Pathology, Spedali Civili of Brescia, Brescia, Italy
| | - Marco Iraci Sareri
- Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Gynecology, University of Catania, Catania, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Enrico Sartori
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Franco Odicino
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
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9
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Abdominal wall mass suspected of endometriosis: clinical and pathologic features. Obstet Gynecol Sci 2020; 63:357-362. [PMID: 32489981 PMCID: PMC7231946 DOI: 10.5468/ogs.2020.63.3.357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/16/2019] [Accepted: 11/06/2019] [Indexed: 12/18/2022] Open
Abstract
Objective To evaluate the clinical and pathological characteristics of lower anterior abdominal wall masses suspicious for endometriosis. Methods A retrospective review of 38 patients who underwent surgery for a lower anterior abdominal wall mass suspicious for endometriosis was performed. Those with skin and intraperitoneal masses, lipomas, hernias, and metastatic malignant masses were excluded. Patient age, body mass index, delivery history, dysmenorrhea, and mass size and location were analyzed. Results Thirty-seven (97.3%) patients had a relevant surgical history, including 35 (92.1%) with a history of cesarean section (C/S). Among the three patients with no history of C/S, 1 underwent total abdominal and another total laparoscopic hysterectomy, and 1 had no previous surgical history. The mean (±standard deviation) size of the abdominal masses was 3.2±1.2 cm. One patient developed a recurrent mass after excision of abdominal wall endometriosis. Trocar site endometrioma was found in one patient following total laparoscopic hysterectomy. According to the final pathology reports, endometriosis was found in 35 (92.1%) of patients. The remaining 3 patients (7.9%) had malignancy: adenocarcinoma, squamous cell carcinoma, and extra-gastrointestinal stromal tumor. Before surgery, only 3 patients (7.9%) underwent fine-needle aspiration biopsy of the masses, which were all postoperatively confirmed to be pathologically benign. Conclusion Although most abdominal wall masses in the present sample were endometriosis occurring at the scar site from a previous operation, 7.9% of patients ultimately exhibited malignancy. Therefore, all patients with suspected anterior wall endometriosis should undergo preoperative biopsy to identify the few that will have an alternative diagnosis.
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10
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Sapalidis K, Machairiotis N, Zarogoulidis P, Vasilakaki S, Sardeli C, Koimtzis G, Pavlidis E, Katsaounis A, Giannakidis D, Michalopoulos N, Mantalobas S, Alexandrou V, Koulouris C, Amaniti A, Kesisoglou I. Genes' Interactions: A Major Contributor to the Malignant Transformation of Endometriosis. Int J Mol Sci 2019; 20:ijms20081842. [PMID: 31013963 PMCID: PMC6515388 DOI: 10.3390/ijms20081842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 12/12/2022] Open
Abstract
The genetic and epigenetic factors that contribute to the malignant transformation of endometriosis are still under investigation. The objective of the present study was to investigate the genetic link between endometriosis and cancer by examining and correlating the latest clinical observations with biological experimental data. We collected updated evidence about the genetic relationship between endometriosis and cancers by conducting a comprehensive search of PubMed and Scopus databases, focusing on the papers published between January 2018 and January 2019. New insights into the mechanism of the malignant transformation of endometriosis have been published recently. The use of state-of-the-art techniques and methods, such as the genome-wide association study analysis and the weighted gene co-expression analysis, have significantly altered our understanding of the association between endometriosis and endometriosis-associated cancer development. Interestingly, the interactions formed between genes seem to play a pivotal role in the phenotypic expression of mutations. Therefore, the effect of single nucleotide polymorphisms and the function of the expression quantitative trait loci on genes’ expression have been the subject of many recent works. In addition, it has been discovered that genes, the mutations of which have been related to the development of endometriosis, play a role as hub genes. This may lead to new areas of research for understanding the mechanism of malignant transformation of the disease. Significant steps forward have been made towards the identification of factors that control the malignant transformation of endometriosis. Still, due to rarity of the event, a better-organized scheme for sampling on a global level should be adopted.
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Affiliation(s)
- Konstantinos Sapalidis
- Department of Obstetrics-Gynaecology, Royal Oldham Hospital, Pennine Accute Trust, Oldham OL12JH, UK.
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, 55236 Thessaloniki, Greece.
| | - Nikolaos Machairiotis
- Department of Obstetrics-Gynaecology, Royal Oldham Hospital, Pennine Accute Trust, Oldham OL12JH, UK.
| | - Paul Zarogoulidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, 55236 Thessaloniki, Greece.
| | - Sofia Vasilakaki
- Department of Chemistry, National and Kapodistrian University of Athens, Panepistimiopolis, 15771 Athens, Greece.
| | - Chrysanthi Sardeli
- Department of Pharmacology & Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 52236 Thessaloniki, Greece.
| | - George Koimtzis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, 55236 Thessaloniki, Greece.
| | - Efstathios Pavlidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, 55236 Thessaloniki, Greece.
| | - Athanasios Katsaounis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, 55236 Thessaloniki, Greece.
| | - Dimitrios Giannakidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, 55236 Thessaloniki, Greece.
| | - Nikolaos Michalopoulos
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, 55236 Thessaloniki, Greece.
| | - Stylianos Mantalobas
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, 55236 Thessaloniki, Greece.
| | - Vyron Alexandrou
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, 55236 Thessaloniki, Greece.
| | - Charilaos Koulouris
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, 55236 Thessaloniki, Greece.
| | - Aikaterini Amaniti
- Anesthesiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, 52236 Thessaloniki, Greece.
| | - Isaak Kesisoglou
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, 55236 Thessaloniki, Greece.
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Arata R, Takakura Y, Ikeda S, Itamoto T. A case of ileus caused by ileal endometriosis with lymph node involvement. Int J Surg Case Rep 2018; 54:90-94. [PMID: 30562695 PMCID: PMC6297261 DOI: 10.1016/j.ijscr.2018.11.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/26/2018] [Indexed: 01/07/2023] Open
Abstract
A definitive preoperative diagnosis of intestinal endometriosis is challenging. Intestinal endometriosis should be considered when examining premenopausal women. Surgery should be considered in patients presenting with intestinal obstruction.
Introduction Endometriosis is characterized by the presence of endometrial tissue outside the uterus. However, the presence of endometriotic lesions in extrauterine locations at the terminal ileum is unusual and a preoperative diagnosis of intestinal endometriosis has proved challenging. Presentation of case A 49-year-old woman visited a local hospital complaining chiefly of vomiting. Computed tomography (CT) revealed an intestinal obstruction, and she was subsequently referred to and admitted to our hospital. After insertion of an ileus tube and contrast infusion, a crab-like stenosis was observed at the end of the ileum. Although its cause was unknown, we believed this stenosis to be the source of obstruction. Another CT at our hospital showed findings of obstructive ileus with a beak sign at the proximal ileum. Laparoscopic examination was performed to investigate the cause of ileus. Since the tumor at the terminal ileum was suspected to be malignant, we converted to laparotomy and performed an ileocecal excision with lymph node dissection. Based on the intraoperative pathological examination, a diagnosis of endometriosis was suspected. Another mass was found in the rectum but we ended the operation at this point. Postoperatively, the patient was referred to a gynecologist for the management of endometriosis. She was discharged on postoperative day 9 without significant complications. Conclusion The non-specific preoperative clinical and radiological findings of ileal endometriosis make it difficult to distinguish it from other diseases. Although rare, ileal endometriosis should be considered as a differential diagnosis of intestinal obstruction in women of reproductive age.
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Affiliation(s)
- Ryosuke Arata
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan
| | - Yuji Takakura
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan.
| | - Satoshi Ikeda
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan
| | - Toshiyuki Itamoto
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan; Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Japan
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