RT Journal Article SR Electronic T1 478 Robotic assisted laparoscopic resection of rectovaginal clear cell carcinoma mass arising from endometriosis JF International Journal of Gynecologic Cancer JO Int J Gynecol Cancer FD BMJ Publishing Group Ltd SP A197 OP A197 DO 10.1136/ijgc-2020-IGCS.417 VO 30 IS Suppl 3 A1 M White A1 F Nezhat YR 2020 UL http://ijgc.bmj.com/content/30/Suppl_3/A197.2.abstract AB Introduction Increasing evidence indicates there is malignant transformation of ovarian and non ovarian endometriosis into mainly endometrioid, and clear cell histologies. Patients that have suspicious symptoms, physical exam findings, or abnormal imaging studies should be evaluated to rule out malignancy. We briefly review the patients history and surgical case as the disease can be elusive.Methods This is a surgical case report involving a single patient. The provider is a Gynecologic Oncologist and minimally invasive surgeon that has extensive experience in the treatment of endometriosis. The surgical technique for endometriosis resection and ovarian cancer debulking is reviewed in this video.Results Pathology specimens of the vaginal cuff/vagina, iliocecum, and appendix were positive for clear cell carcinoma. Negative margins were achieved at the vagina.Patient was treated with adjuvant chemotherapy with whole pelvic and vaginal brachytherapy.Conclusion Management of patients with cancer arising from endometriosis can be challenging. Patients with endometriosis should be evaluated for malignancy with suspicious imaging findings. Optimal surgical resection followed by adjuvant chemotherapy or/and radiation is the current recommendation. Robotic Assisted Laparoscopy is feasible and may be preferable for debulking/resection of complex masses in the rectovaginal space in obese patients.