Incisional carcinoma of Mullerian Origin: A case report and review of literature
Primary incisional carcinoma (PIC) is a rare, delayed complication of surgery, usually attributed to the malignant transformation of endometriosis.We report a case of incisional carcinoma with nodal metastases in a 55-year-old woman, 18 years after cesarean section. She underwent extirpative surgery...
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doaj-a2e66a32ad9d4c62af94c984732068122020-11-25T03:26:56ZengElsevierGynecologic Oncology Reports2352-57892020-08-0133100588Incisional carcinoma of Mullerian Origin: A case report and review of literatureSabrina Bedell0Zenas Chang1Cassaundra Burt2Mahmoud A. Khalifa3Peter A. Argenta4Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, MN, United StatesDivision of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, MN, United StatesDivision of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, MN, United StatesDepartment of Pathology and Laboratory Medicine, University of Minnesota, Minneapolis, MN, United StatesDivision of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, MN, United States; Corresponding author at: MMC 395, 420 Delaware St SE, Minneapolis, MN 55455, United States.Primary incisional carcinoma (PIC) is a rare, delayed complication of surgery, usually attributed to the malignant transformation of endometriosis.We report a case of incisional carcinoma with nodal metastases in a 55-year-old woman, 18 years after cesarean section. She underwent extirpative surgery, including hysterectomy and bilateral salpingo-oophorectomy, without intraperitoneal disease identifed. Adjuvant treatment included sandwiched platinum-based chemotherapy (carboplatin and paclitaxel) and radiation. She remains disease-free 8 months after completing therapy.We identified 46 additional reported cases. Of these, >90% had undergone an “endometrium-exposing” surgery, most commonly cesarean section; while no cases followed adnexal-only surgery. The median time between antecedent surgery and presentation was 18 years. At presentation, tumors were often large (median 8 cm), and symptomatic with pain (63%) and/or mass (26%). Serum CA125 levels were commonly, albeit slightly, elevated (median 57U/ml (IQR 22–96, Range 6–1690)). Lymph node metastases were common (35%), with most following a vulvar-type spread pattern (inguinal first). Most patients (63%) were treated with chemotherapy +/− radiation. Approximately 50% of patients recurred promptly (median < 6 months), but long-term survival was reported following combined chemotherapy/radiation. Lymph node metastases portended a shorter disease-free interval, with 73% of cases recurring (median 5 months) despite chemotherapy-based treatment.These data suggest that some incisional carcinomas may result from displacement of healthy endometrium followed by delayed malignant transformation. Chemotherapy-only and radiation-only treatments are attended by modest prognosis. Taken together, these data suggest there is both need and potential avenues for improved prevention, detection, and treatment of this condition.http://www.sciencedirect.com/science/article/pii/S2352578920300540Incisional carcinomaAbdominal wall metastasesEndometrioid carcinoma |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sabrina Bedell Zenas Chang Cassaundra Burt Mahmoud A. Khalifa Peter A. Argenta |
spellingShingle |
Sabrina Bedell Zenas Chang Cassaundra Burt Mahmoud A. Khalifa Peter A. Argenta Incisional carcinoma of Mullerian Origin: A case report and review of literature Gynecologic Oncology Reports Incisional carcinoma Abdominal wall metastases Endometrioid carcinoma |
author_facet |
Sabrina Bedell Zenas Chang Cassaundra Burt Mahmoud A. Khalifa Peter A. Argenta |
author_sort |
Sabrina Bedell |
title |
Incisional carcinoma of Mullerian Origin: A case report and review of literature |
title_short |
Incisional carcinoma of Mullerian Origin: A case report and review of literature |
title_full |
Incisional carcinoma of Mullerian Origin: A case report and review of literature |
title_fullStr |
Incisional carcinoma of Mullerian Origin: A case report and review of literature |
title_full_unstemmed |
Incisional carcinoma of Mullerian Origin: A case report and review of literature |
title_sort |
incisional carcinoma of mullerian origin: a case report and review of literature |
publisher |
Elsevier |
series |
Gynecologic Oncology Reports |
issn |
2352-5789 |
publishDate |
2020-08-01 |
description |
Primary incisional carcinoma (PIC) is a rare, delayed complication of surgery, usually attributed to the malignant transformation of endometriosis.We report a case of incisional carcinoma with nodal metastases in a 55-year-old woman, 18 years after cesarean section. She underwent extirpative surgery, including hysterectomy and bilateral salpingo-oophorectomy, without intraperitoneal disease identifed. Adjuvant treatment included sandwiched platinum-based chemotherapy (carboplatin and paclitaxel) and radiation. She remains disease-free 8 months after completing therapy.We identified 46 additional reported cases. Of these, >90% had undergone an “endometrium-exposing” surgery, most commonly cesarean section; while no cases followed adnexal-only surgery. The median time between antecedent surgery and presentation was 18 years. At presentation, tumors were often large (median 8 cm), and symptomatic with pain (63%) and/or mass (26%). Serum CA125 levels were commonly, albeit slightly, elevated (median 57U/ml (IQR 22–96, Range 6–1690)). Lymph node metastases were common (35%), with most following a vulvar-type spread pattern (inguinal first). Most patients (63%) were treated with chemotherapy +/− radiation. Approximately 50% of patients recurred promptly (median < 6 months), but long-term survival was reported following combined chemotherapy/radiation. Lymph node metastases portended a shorter disease-free interval, with 73% of cases recurring (median 5 months) despite chemotherapy-based treatment.These data suggest that some incisional carcinomas may result from displacement of healthy endometrium followed by delayed malignant transformation. Chemotherapy-only and radiation-only treatments are attended by modest prognosis. Taken together, these data suggest there is both need and potential avenues for improved prevention, detection, and treatment of this condition. |
topic |
Incisional carcinoma Abdominal wall metastases Endometrioid carcinoma |
url |
http://www.sciencedirect.com/science/article/pii/S2352578920300540 |
work_keys_str_mv |
AT sabrinabedell incisionalcarcinomaofmullerianoriginacasereportandreviewofliterature AT zenaschang incisionalcarcinomaofmullerianoriginacasereportandreviewofliterature AT cassaundraburt incisionalcarcinomaofmullerianoriginacasereportandreviewofliterature AT mahmoudakhalifa incisionalcarcinomaofmullerianoriginacasereportandreviewofliterature AT peteraargenta incisionalcarcinomaofmullerianoriginacasereportandreviewofliterature |
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