Published: Вс, Февраля 05, 2017
World | By Tasha Manning

Clear cell adenocarcinoma arising from abdominal wall endometriosis



Clear cell carcinoma originating in the abdominal wall is a rare event. It is generally associated with endometrial tissue implants left behind after a caesarean section or other gynecological operations. Its pathophysiology is complex and controversial.

Clinical case

The case is presented from a 45 year-old female with a history of three caesarean sections, who was seen due to having a tumor mass Of 6 months onset in the anterior abdominal wall. Imaging studies confirmed its location, and due to measuring 9 cm × 7 cm it was suspected to be an urachal tumor. A resection with wide margins was performed. The histopathology report was of a clear cell adenocarcinoma originated in ectopic endometrial tissue, with negative margins.


This is a very rare case, with few cases reported in the literature. Abstract Background

Clear cell carcinoma originated in the pancreatic cancer of the uterus.

Abdominal wall is a rare entity and is usually associated with iatrogenic implants of endometrial tissue, a surgical incision during cesarean section or other gynecological procedures, its pathophysiology is complex and controversial.

Clinical case

A 45-year-old female patient with a history of 3 cesareans, who presented with a tumor mass in the anterior wall of the abdomen of 6 months of evolution. The imaging studies confirmed its location, with dimensions of 9 by 7 cm that made suspicion in a tumor of the urachus; With this diagnosis it was decided to carry out a wide resection. The final report of pathology was clear cell adenocarcinoma originated in the endometriotic focus, with negative surgical margins.


The presence and growth of endometrial tissues outside the uterus is called endometriosis and if it forms cystic mass it is known endometrioma; Its prevalence is variable, during reproductive age, ranging from 10% to 30-50% when it is associated with pelvic pain and infertility. Average age of presentation is 30 (range between 25 and 35). The pelvic cavity is the main site (75% in the ovary) but any part of the body may be affected (lung, eye, brain, soft tissues). The abdominal wall is the most frequent extra-pelvic site. Its physiopathology is complex and controversial, and several theories exist to explain its origin, including: retrograde menstruation, epithelium cell metaplasia, vascular and lymphatic dissemination, activation of embryonic remains and iatrogenic implants during an open surgery or laparoscopic procedure of gynecological surgery such as caesarean Section (57% cases) and hysterectomies.

Incidence is between 0.03% and 3.5%. Malignant transformation is extremely rare, but has been described since 1925.

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It appears as a subcutaneous progressive growth mass associated with cyclical pain during menstruation. Abdominal wall, biopsy for reporting malignancy, which is complemented by computed axial tomography for assessing spread and resectability.

Differential diagnostics include benign causes, such as incisional hernia, haematoma of the abdominal rectus muscle lining, and primary or Metastatic neoplasms of the abdominal wall.

Treatment is extensive resection with reconstruction of the abdominal wall which generally leads to good oncological outcome. However, experience is limited due to the rare occurrence of this entity.

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