Bedell Sabrina, Chang Zenas, Burt Cassaundra, Khalifa Mahmoud A, Argenta Peter A
Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, MN, United States.
Department of Pathology and Laboratory Medicine, University of Minnesota, Minneapolis, MN, United States.
Gynecol Oncol Rep. 2020 May 22;33:100588. doi: 10.1016/j.gore.2020.100588. eCollection 2020 Aug.
Primary incisional carcinoma (PIC) is a rare, delayed complication of surgery, usually attributed to the malignant transformation of endometriosis. We report a case of incisional carcinoma with nodal metastases in a 55-year-old woman, 18 years after cesarean section. She underwent extirpative surgery, including hysterectomy and bilateral salpingo-oophorectomy, without intraperitoneal disease identifed. Adjuvant treatment included sandwiched platinum-based chemotherapy (carboplatin and paclitaxel) and radiation. She remains disease-free 8 months after completing therapy. We identified 46 additional reported cases. Of these, >90% had undergone an "endometrium-exposing" surgery, most commonly cesarean section; while no cases followed adnexal-only surgery. The median time between antecedent surgery and presentation was 18 years. At presentation, tumors were often large (median 8 cm), and symptomatic with pain (63%) and/or mass (26%). Serum CA125 levels were commonly, albeit slightly, elevated (median 57U/ml (IQR 22-96, Range 6-1690)). Lymph node metastases were common (35%), with most following a vulvar-type spread pattern (inguinal first). Most patients (63%) were treated with chemotherapy +/- radiation. Approximately 50% of patients recurred promptly (median < 6 months), but long-term survival was reported following combined chemotherapy/radiation. Lymph node metastases portended a shorter disease-free interval, with 73% of cases recurring (median 5 months) despite chemotherapy-based treatment. These data suggest that some incisional carcinomas may result from displacement of healthy endometrium followed by delayed malignant transformation. Chemotherapy-only and radiation-only treatments are attended by modest prognosis. Taken together, these data suggest there is both need and potential avenues for improved prevention, detection, and treatment of this condition.
原发性切口癌（PIC）是一种罕见的手术延迟并发症，通常归因于子宫内膜异位症的恶性转化。我们报告一例55岁女性在剖宫产术后18年发生的伴有淋巴结转移的切口癌。她接受了根治性手术，包括子宫切除术和双侧输卵管卵巢切除术，术中未发现腹腔内病变。辅助治疗包括夹心铂类化疗（卡铂和紫杉醇）及放疗。完成治疗8个月后，她仍无疾病复发。我们又找到了46例已报道的病例。其中，超过90%的患者接受过“暴露子宫内膜”的手术，最常见的是剖宫产；而没有仅行附件手术的病例。前次手术与发病之间的中位时间为18年。发病时，肿瘤通常较大（中位直径8cm），症状表现为疼痛（63%）和/或肿块（26%）。血清CA125水平通常虽略有升高（中位值57U/ml（四分位间距22 - 96，范围6 - 1690））。淋巴结转移很常见（35%），大多数遵循外阴型扩散模式（首先转移至腹股沟）。大多数患者（63%）接受了化疗±放疗。约50%的患者迅速复发（中位时间<6个月），但联合化疗/放疗后有长期生存的报道。淋巴结转移预示无病间期较短，尽管接受了以化疗为主的治疗，但73%的病例仍复发（中位时间5个月）。这些数据表明，一些切口癌可能是由健康子宫内膜移位后发生延迟恶性转化所致。单纯化疗和单纯放疗的预后一般。综合来看，这些数据表明在改善这种疾病的预防、检测和治疗方面既有需求也有潜在途径。
