Clear Cell Carcinoma Arising in an Abdominal Wall Cesarean Section Scar: A Case Report With Description of Pathological and Molecular Features

Clear cell carcinoma is a clinically and biologically distinct type of carcinoma predominantly encountered in the ovary and endometrium. In the ovary, it is frequently associated with endometriosis, which is a well-known risk factor. Endometriosis has often been described in the abdominal wall of women who had a cesarean section; however, malignant transformation is a very rare event, occurring in <1% of cases. The authors report a case involving a 52-year-old woman with an abdominal wall nodule at a cesarean section scar. Radiology revealed a mass, measuring 8 cm in size, in the abdominal wall suggestive of a soft tissue tumor. After resection, histology revealed the presence of clear, eosinophilic, and hobnail cells, which, together with immunohistochemical and molecular findings, enabled the diagnosis of clear cell carcinoma of the abdominal wall. The present report describes the clinical, radiological, pathological, and molecular features of an unusual abdominal lesion that represents a rare but challenging diagnosis.

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Clear cell adenocarcinoma arising from the abdominal wall after cesarean section in a patient with uterine adenomyosis

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa070 ◽

2020 ◽

Vol 2020 (4) ◽

Author(s):

Anaïs Provendier ◽

Martina Aida Angeles ◽

Olivier Meyrignac ◽

Claire Illac ◽

Anne Ducassou ◽

...

Keyword(s):

Cesarean Section ◽

Abdominal Wall ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Rare Event ◽

Surgical Excision ◽

Gynecologic Surgery ◽

Clear Cell Adenocarcinoma ◽

Uterine Adenomyosis ◽

History Of

Abstract Malignant transformation of abdominal wall endometriosis lesions developed in a cesarean section scar is a rare event. Patients with uterine adenomyosis but without endometriosis can also develop abdominal wall malignant carcinoma after a gynecologic surgery. The treatment of abdominal wall clear cell adenocarcinoma combines tumor surgical excision with free margins, radiotherapy and chemotherapy. We report a case of clear cell carcinoma arising from an abdominal wall cesarean section scar in a patient without history of endometriosis.

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Abdominal Wall Clear Cell Carcinoma: Case Report of a Rare Event with Potential Diagnostic Difficulties

Case Reports in Pathology ◽

10.1155/2019/1695734 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Maria del Mar Rivera Rolon ◽

Dyron Allen ◽

Gwyn Richardson ◽

Cecilia Clement

Keyword(s):

Cell Carcinoma ◽

Abdominal Wall ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Rare Event ◽

Rectus Muscle ◽

Pubic Bone ◽

Cystic Neoplasm ◽

Nuclear Atypia ◽

Diagnostic Difficulties

Clear cell carcinoma (CCC) is a well-known aggressive histological type of carcinoma, predominantly seen in ovary and endometrium. However, CCC arising in abdominal wall is a very rare event. We report a case of a 48-year-old woman with an abdominal wall mass at her cesarean section (c-section) scar, which increased in size and became painful in the last months. Radiology revealed a 7 cm mass in the right inferior rectus muscle sheath, suggestive of endometriosis. An irregular, firm mass was resected, densely adherent to the rectus muscle and pubic bone. Frozen section revealed a multicystic lesion with minimal cytologic atypia, and a benign cystic neoplasm was favored. However, permanent sections showed marked nuclear atypia, hobnail morphology, and areas of infiltrative growth within fibrous stroma. No benign endometrial glands were found, although fibrosis and hemorrhage were present. Napsin-A, racemase, and PAX-8 were positive, consistent with CCC, likely arising within a c-section endometriosis focus. Although CCC usually presents with moderate to marked nuclear atypia, it can be mild and, especially in cases with a predominant cystic pattern, create diagnostic difficulties. An endometriosis-associated malignancy should be considered in the differential with any enlarging nodule or increasing pain within an abdominal wall scar.

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Clear cell carcinoma arising from abdominal wall endometrioma after cesarean section

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000808 ◽

2019 ◽

Vol 29 (8) ◽

pp. 1332-1335

Author(s):

Andre Lopes ◽

Cristina Anton ◽

Brian M Slomovitz ◽

Leandro Accardo de Mattos ◽

Filomena Marino Carvalho

Keyword(s):

Cesarean Section ◽

Cell Carcinoma ◽

Abdominal Wall ◽

Clear Cell ◽

Clear Cell Carcinoma

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Clear Cell Carcinoma of the abdominal wall

Polish Journal of Surgery ◽

10.5604/01.3001.0010.6753 ◽

2017 ◽

Vol 89 (6) ◽

pp. 40-43 ◽

Cited By ~ 1

Author(s):

Ewa Kostrzeba ◽

M. Barczyk ◽

M. Wichtowski ◽

R. Garstecki ◽

D. Murawa

Keyword(s):

Cesarean Section ◽

Cell Carcinoma ◽

Abdominal Wall ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Good Condition ◽

Gjb2 Gene ◽

Control Group ◽

Exon 2 ◽

Group I

Background: Clear cell carcinoma in scars after cesarean section is extremely rare, with only 22 cases reported in the literature. Management of this condition needs to be further explored. Here, we report of a patient with clear cell carcinoma of the abdominal wall that developed 35 years after cesarean section. Case Report: The material of the study was a group of 61 patients divided into two groups. Group I – 35 deaf or with profound sensorineural hearing loss children (the pupils of the deaf and hard of hearing school), aged 5–17 years (average 9,2 years), 14 males, 21 females, II – control group comprised 26 normal hearing patients, aged 5–16 years (average 10,4 years), 14 males, 12 females (patients of Department of Pediatric Otolaryngology, Audiology and Phoniatrics, Medical University of Lodz). In both groups, exon 2 sequencing of GJB2 gene was performed. Results. A 58-year-old woman was admitted to our department due to abdominal pain and a progressively growing mass in the abdominal wall. Based on biopsy, a preliminary diagnosis of clear cell carcinoma was made. A wide surgical excision of the tumor with clear margins, hysterectomy with bilateral salpingo-oophorectomy, and abdominal wall reconstruction using synthetic mesh were performed. The patient was discharged in good condition after fifteen days of hospitalization. The patient remained recurrence-free 6 months after the treatment. Conclusions: T Lack of standardized management of rare malignant transformations hinders patient care. Due to a growing number of cesarean deliveries, we can expect clear cell carcinoma prevalence of the abdominal wall to increase. Therefore, patients and clinicians should attend to any pain, itching, or change in the size of abdominal wall scars.

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Clear-cell carcinoma originating from cesarean section scar: two case reports

Journal of Medical Case Reports ◽

10.1186/s13256-021-02775-9 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Seyedeh Razieh Hashemi ◽

Mahdi Morshedi ◽

Houshyar Maghsoudi ◽

Arezoo Esmaeilzadeh ◽

Ibrahim Alkatout

Keyword(s):

Cesarean Section ◽

Cell Carcinoma ◽

Abdominal Wall ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Case Reports ◽

Pubic Symphysis ◽

Tumor Spread ◽

Complete Surgical Excision ◽

Wall Mass

Abstract Background Clear-cell carcinoma arising from the surgical cesarean section scar is very infrequent. The present study reports two patients with clear-cell carcinoma arising from an abdominal wall scar 20 and 23 years after their last cesarean section. Case presentation Both Iranian patients had prior cesarean sections nearly 20 years earlier. Patients 1 and 2 had transverse and vertical abdominal incisions, respectively. The initial clinical presentation was a huge lower abdominal mass at the site of the previous cesarean section scar. Both patients underwent abdominal wall mass biopsy. The histological analysis revealed the presence of malignancy. Both patients underwent full-thickness resection of the abdominal wall mass. All surgical margins were tumor-free; however, patient 1 had a very narrow tumor-free margin near the pubic symphysis. As the imaging report of patient 2 revealed the presence of a pelvic mass, the exploration of the intraperitoneal space, simple total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and the excision of enlarged pelvic lymph nodes were performed during the surgery. Six cycles of paclitaxel and carboplatin every 3 weeks as adjuvant chemotherapy was administered for both patients after the surgery. One of the patients had disease recurrence 5 months after the termination of chemotherapy, and the other is still disease-free. These two patients had similar pathology and received a similar initial adjuvant treatment; however, they were different in terms of the direction of tumor spread, tumor distance from the pubic symphysis, status of tumor margins, and surgical procedures. Conclusions We encountered distinct prognoses in the clear-cell carcinoma of cesarean section scars presented herein. The researchers can recommend complete surgical excision of the abdominal wall mass with wide tumor-free margins, exploration of the abdominopelvic space, TAH, and BSO during the first surgery.

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Genomic Sub-Classification of Ovarian Clear Cell Carcinoma Revealed by Distinct Mutational Signatures

Cancers ◽

10.3390/cancers13205242 ◽

2021 ◽

Vol 13 (20) ◽

pp. 5242

Author(s):

Douglas V. N. P. Oliveira ◽

Tine H. Schnack ◽

Tim S. Poulsen ◽

Anne P. Christiansen ◽

Claus K. Høgdall ◽

...

Keyword(s):

Cell Carcinoma ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Gynecologic Cancer ◽

Ovarian Clear Cell Carcinoma ◽

Double Mutation ◽

Cancer Subtypes ◽

Pik3ca Mutations ◽

Molecular Features ◽

Dismal Prognosis

Ovarian clear cell carcinoma (OCCC) is characterized by dismal prognosis, partially due to its low sensitivity to standard chemotherapy regimen. It is also well-known for presenting unique molecular features in comparison to other epithelial ovarian cancer subtypes. Here, we aim to identify potential subgroups of patients in order to (1) determine their molecular features and (2) characterize their mutational signature. Furthermore, we sought to perform the investigation based on a potentially clinically relevant setting. To that end, we assessed the mutational profile and genomic instability of 55 patients extracted from the Gynecologic Cancer Database (DGCD) by using a panel comprised of 409 cancer-associated genes and a microsatellite assay, respectively; both are currently used in our routine environment. In accordance with previous findings, ARID1A and PIK3CA were the most prevalent mutations, present in 49.1% and 41.8%, respectively. From those, the co-occurrence of ARID1A and PIK3CA mutations was observed in 36.1% of subjects, indicating that this association might be a common feature of OCCC. The microsatellite instability frequency was low across samples. An unbiased assessment of signatures identified the presence of three subgroups, where “PIK3CA” and “Double hit” (with ARID1A and PIK3CA double mutation) subgroups exhibited unique signatures, whilst “ARID1A” and “Undetermined” (no mutations on ARID1A nor PIK3CA) subgroups showed similar profiles. Those differences were further indicated by COSMIC signatures. Taken together, the current findings suggest that OCCC presents distinct mutational landscapes within its group, which may indicate different therapeutic approaches according to its subgroup. Although encouraging, it is noteworthy that the current results are limited by sample size, and further investigation on a larger group would be crucial to better elucidate them.

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