Department of Obstetrics and Gynecology, Spedali Civili of Brescia, Brescia, Italy.
Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Gynecology, University of Catania, Catania, Italy.
J Obstet Gynaecol Res. 2021 Apr;47(4):1243-1252. doi: 10.1111/jog.14635. Epub 2021 Jan 13.
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).
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.
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.
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.
剖宫产术（CS）的疤痕是腹壁子宫内膜异位症（AWE）最常见的部位，其肿瘤变性的报道病例越来越多；最常见的组织学类型是透明细胞癌（CCC）。
我们对文献进行了系统研究，收集了关于 CS 后 AWE 肿瘤变性的证据数据。此外，我们报告了一例起源于 AWE 的透明细胞交界性肿瘤（CCBT）。
我们纳入了 37 例诊断为 CCC 的患者数据。最后一次 CS 与 CCC 诊断之间的平均时间约为 15 年。总体而言，26.0%和 73.9%的患者分别接受了病变的局部腹部切除术和附加手术。26.0%的患者淋巴结受累，52.0%的患者接受了辅助化疗。在随访期间，15.2%的患者死于疾病，32.6%的患者无疾病证据，17.4%的患者复发。我们诊断了一例 CCBT 起源于 AWE 患者，该患者有子宫内膜异位症、CS 和随后的横切口手术的多次手术史。我们进行了开放性双侧卵巢切除术和对子宫内膜异位腹部病变的大切除。
AWE 的肿瘤变性似乎是一种真实的发生，其事件数量不断增加。鉴于缺乏肿瘤变性的风险因素和诊断工具，即使触发手术和肿瘤发现之间的平均时间较长，也可能建议切除 AWE 定位。
