Abdominal wall clear cell carcinoma arising on cesarean-scar endometriosis: a case report
4 affiliations
- 1Department of Gynecologic Oncology, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- 2Department of Gynecology Pathology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
- 3Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
- 4Department of Gynecologic Oncology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Introduction:: Clear cell carcinoma (CCC) arising from abdominal wall endometriosis (AWE) is an exceptionally rare malignancy, most often developing years after a cesarean section. Because of its nonspecific presentation and the limited published experience, diagnosis is frequently delayed and optimal management remains undefined.
Case presentation:: A 48-year-old woman with a history of cesarean section 20 years earlier presented with a progressively enlarging abdominal wall mass at the cesarean scar, accompanied by constitutional symptoms. Magnetic resonance imaging revealed a solid, infiltrative abdominal wall lesion with regional lymphadenopathy, while core biopsy suggested metastatic serous carcinoma. Following three cycles of neoadjuvant carboplatin and paclitaxel, the patient underwent complete cytoreductive surgery, including wide abdominal wall excision, total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and omentectomy. Final histopathology confirmed CCC arising from AWE, with metastatic involvement of one inguinal lymph node and no evidence of a gynecologic primary tumor. Adjuvant chemotherapy, followed by maintenance bevacizumab, was administered, and postoperative imaging demonstrated no residual disease. She remains disease-free 2 years after surgery.
Clinical discussion:: Malignant transformation of AWE should be suspected when a long-standing cesarean scar lesion demonstrates rapid growth, solid components, regional lymphadenopathy, or elevated tumor markers. Diagnosis may be challenging preoperatively due to tumor heterogeneity. Management relies on complete cytoreduction with platinum-based chemotherapy, while targeted therapies may offer additional benefit in select patients.
Conclusion:: This case highlights the importance of maintaining clinical suspicion of malignant transformation in patients with scar endometriosis. Early recognition, multidisciplinary evaluation, and aggressive multimodal treatment are critical for improving outcomes in this rare disease.
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BibTeX
@article{mousavi2026abdominal,
title = {{Abdominal wall clear cell carcinoma arising on cesarean-scar endometriosis: a case report}},
author = {Azam S. Mousavi and Soheila Sarmadi and Fahimeh Zeinalkhani and Sara Ramhormozian},
journal = {International Journal of Surgery Case Reports},
year = {2026},
month = oct,
doi = {10.1097/rc9.0000000000001107},
url = {https://doi.org/10.1097/rc9.0000000000001107},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Abdominal wall clear cell carcinoma arising on cesarean-scar endometriosis: a case report
AU - Azam S. Mousavi
AU - Soheila Sarmadi
AU - Fahimeh Zeinalkhani
AU - Sara Ramhormozian
PY - 2026
DA - 2026/10/21
JO - International Journal of Surgery Case Reports
DO - 10.1097/rc9.0000000000001107
UR - https://doi.org/10.1097/rc9.0000000000001107
AB - Introduction:: Clear cell carcinoma (CCC) arising from abdominal wall endometriosis (AWE) is an exceptionally rare malignancy, most often developing years after a cesarean section. Because of its nonspecific presentation and the limited published experience, diagnosis is frequently delayed and optimal management remains undefined. Case presentation:: A 48-year-old woman with a history of cesarean section 20 years earlier presented with a progressively enlarging abdominal wall mass at the cesarean scar, accompanied by constitutional symptoms. Magnetic resonance imaging revealed a solid, infiltrative abdominal wall lesion with regional lymphadenopathy, while core biopsy suggested metastatic serous carcinoma. Following three cycles of neoadjuvant carboplatin and paclitaxel, the patient underwent complete cytoreductive surgery, including wide abdominal wall excision, total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and omentectomy. Final histopathology confirmed CCC arising from AWE, with metastatic involvement of one inguinal lymph node and no evidence of a gynecologic primary tumor. Adjuvant chemotherapy, followed by maintenance bevacizumab, was administered, and postoperative imaging demonstrated no residual disease. She remains disease-free 2 years after surgery. Clinical discussion:: Malignant transformation of AWE should be suspected when a long-standing cesarean scar lesion demonstrates rapid growth, solid components, regional lymphadenopathy, or elevated tumor markers. Diagnosis may be challenging preoperatively due to tumor heterogeneity. Management relies on complete cytoreduction with platinum-based chemotherapy, while targeted therapies may offer additional benefit in select patients. Conclusion:: This case highlights the importance of maintaining clinical suspicion of malignant transformation in patients with scar endometriosis. Early recognition, multidisciplinary evaluation, and aggressive multimodal treatment are critical for improving outcomes in this rare disease.
SN - 2210-2612
ER -