由子宮內膜異位症衍生之腹壁透明細胞癌:一病例報告
Abdominal Wall Clear Cell Carcinoma Arising from Endometriosis : A Case
Report
張穎宜
1,2,3張慧雯
4林武周
1,5,張維君
1,2,陳慧毅
1,5,洪耀欽
1,2葉聯舜
1,2Cherry Yin-Yi Chang, M.D.,M.P.H
.,1,2,3Hui-Wen Chang,M.D
.,4, Wu-Chou Lin M.D,PhD.
1,5,Wei-Chun Chang M.D, Ph.D,
1,2, Huei-Yi Chen MD, PhD.,
1,5, Yao-Ching Hung,M.D.,Ph.D.
1,2,
Lian-Shung Yeh, M.D.,
1,2,
1.中國藥大學附設醫院婦產部 2.中國藥大學醫學院醫學系 3.中國藥大學公共衛生學院,
4.中國醫藥大學附設醫院病理部 5.中國藥大學醫學院中醫學系
1.Department of Obstetrics and Gynecology, China Medical University Hospital, Taiwan
2.Department of medicine, China Medical University, Taiwan
3.Institute of Public Health, China Medical University, Taiwan
4.Department of pathology, China Medical University, Taiwan
5. Department of Chinese Medicine, China Medical University,Taiwan.
Objective:To report a case of abdominal wall clear cell adenocarcinoma arising from endometriosis.
Case Report: Abdominal wall clear cell adenocarcinoma arising from endometriosis is rare but highly
malignant neoplasm. We describe a case of abdominal wall clear cell carcinoma arising from endometriosis. This 54 year old female patient accepted abdominal total hysterectomy and local excision of abdominal mass operation due to adenomyosis and myoma with menorrhagia and dysmenorrhea and mass of abdominal wall in 2010. Pathology showed adenomyosis and uterine myoma of uterus and clear cell carcinoma of abdominal wall. Six months after operation, she noted recurrent abdominal mass of right internal oblique muscle so she accepted local excision of the mass and pathology showed invasive clear cell carcinoma arising in the background of clear cell cystadenoma arising from endometriosis. CA-125, CEA, CA-199 level were checked and was 8.6IU/mL, 2.97 ng/ml, 24.5 U/ml respectively. Whole body CT and chest X ray showed no disseminated disease. Six courses of chemotherapy ( carboplatin: AUC:6 plus paclitaxel: 175 mg/m2) and radiation ( 6000 cGy/30 Fr) were performed. Patient’s condition was stable until one year after adjuvant chemotherapy and radiation treatment. Patient had recurrent abdominal wall mass and MRI showed 5.7*3cm cystic lesion with marginal enhancement of the lower anterior abdominal wall, enlarged lymph node at bilateral inguinal regions and pelvic lymph node and tumor invasion in the superior ramus of bilateral pubic bones. PET/CT showed the same result of MRI and intensely increased FDG radioactivity in the subcarinal and left pulmonary hilar lymph node. So, patient accepted salvage chemotherapy (weekly carboplatin and gemcitabine) and condition was stable now.
Conclusion:There was few case of abdominal wall clear cell carcinoma arising from endometriosis.
Patient with history of endometriosis had rapid growth of abdominal mass should be considered and warrant detailed examination and aggressive treatment.
H&E ×400:Clear cell carcinoma with tubulocystic
Architecture.
H&E ×400: Clear cell carcinoma with polyhedral shapes and variability in the size and shape..
