Work

Abdominal wall clear cell carcinoma arising on cesarean-scar endometriosis: a case report

Year: 2026

Type: article

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.

Source: International Journal of Surgery Case Reports

DOI: 10.1097/rc9.0000000000001107

Authors: Azam S. Mousavi, Soheila Sarmadi, Fahimeh Zeinalkhani, Sara Ramhormozian

Institutions: Tehran University of Medical Sciences, Yas Hospital, Imam Khomeini Hospital, Advanced Diagnostic and Interventional Radiology Research Center

Language: English

Topic: Endometriosis Research and Treatment

Subfield: Reproductive Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090