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Abstract
Introduction/Background Endometriosis can occur in extra pelvic locations. Abdominal wall endometriomas (AWE) usually occur as a secondary process to gynecological surgeries, most often caesarean, with an incidence between 0.03 to 0.45% and only 1% can be malignant.
Methodology 34-year-old patient who consulted due to dysmenorrhea, antecedent of two caesarean, to physical examination with nodular lesion in abdominal wall in relation to surgical scar, Ca 125: 696.60, pelvic ultrasound normal, in Abdominal and pelvic resonance of thickening and distortion of the straight muscles in the suprapubic region of the abdominal wall, conglomerate 84 * 68 * 39 mm. The diagnosis of AWE is made, she´s carried out to resection where a 10 x 15 cm lesion is evidenced, pathology report a moderately differentiated adenocarcinoma of endometrioid appearance.
The rarity presentation of a primary endometrioid adenocarcinoma in the abdominal wall, possible endometrial or ovarian origin are studied. She´s led to gynecological curettage reported as negative for hyperplasia / malignancy, CT scan with adnexal cystic lesion, primary ovarian is suspected, is decided to cytoreduction. Pathology report: adenomyotic uterus, parametria with endometriosis, 72 lymph node free of tumor. She´s assessed by clinical oncology and before non-standard management, decided clinical observation without evidence of tumor after 8 months of follow-up.
Results It was considered a rare case of a primary endometrioid adenocarcinoma of the abdominal wall and the most common histological type is clear cell adenocarcinoma (62%). The histopathological criteria of Sampson-Scott, such as the coexistence of benign and malignant endometrial tissue in the tumor, histological appearance consistent with endometrial origin and excluding another primary tumor site allow to confirm the diagnosis.
Abdominal and pelvic resonance
Immunohistochemistry
Conclusion The malignization of the AWE is a rare clinical entity and the histological type endometrioid is even more rare, in terms of management wide local excision with free margins is the key point to prevent recurrence.
Disclosure Nothing to disclose