Ijichi Sakura, Mori Taisuke, Suganuma Izumi, Yamamoto Takuro, Matsushima Hiroshi, Ito Fumitake, Akiyama Makoto, Kusuki Izumi, Kitawaki Jo
Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
Case Rep Obstet Gynecol. 2014;2014:642483. doi: 10.1155/2014/642483. Epub 2014 Nov 2.
Introduction. The incidence of endometriosis affecting skin tissue represents only 0.5-1.0% of all endometriosis cases. A malignancy in the abdominal wall arising from endometriosis following cesarean section is even rarer; only 21 cases have previously been reported. The therapeutic strategy has not been determined because of the limited cases. We report a case of clear cell adenocarcinoma arising in the abdominal wall from endometriosis tissues following cesarean section and review previous literature to achieve the optimal treatment and better prognosis. Case Presentation. A 60-year-old woman presented with a growing mass at the left side of a cesarean section scar. Radical resection of the abdominal wall mass was performed. Histopathological examination showed a clear cell adenocarcinoma. Benign endometrium-like tissues were found adjacent to the cancer lesion in the excised specimen, suggesting malignant transformation from endometriosis of the abdominal wall. Discussion. Local resection was performed in 10 cases (47.6%) and total abdominal hysterectomy or oophorectomy was conducted in 11 cases (52.4%). No malignant lesions were observed in either the uterus or adnexa that were resected. These cases may be expected to increase with increasing incidence of cesarean section. The significance of the extensional resection should be further elucidated.
引言。累及皮肤组织的子宫内膜异位症发病率仅占所有子宫内膜异位症病例的0.5 - 1.0%。剖宫产术后腹壁因子宫内膜异位症引发的恶性肿瘤更为罕见；此前仅报道过21例。由于病例有限，治疗策略尚未确定。我们报告一例剖宫产术后腹壁子宫内膜异位症组织发生的透明细胞腺癌病例，并回顾既往文献以实现最佳治疗和更好的预后。病例报告。一名60岁女性，剖宫产瘢痕左侧出现逐渐增大的肿块。对腹壁肿块进行了根治性切除。组织病理学检查显示为透明细胞腺癌。在切除标本中，癌灶附近发现良性子宫内膜样组织，提示腹壁子宫内膜异位症发生了恶性转化。讨论。10例（47.6%）进行了局部切除，11例（52.4%）进行了全腹子宫切除术或卵巢切除术。切除的子宫或附件均未观察到恶性病变。随着剖宫产发病率的增加，此类病例可能会增多。扩大切除的意义应进一步阐明。
