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class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Is abdominal wall endometriosis always a benign pathology?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "61" "paginaFinal" => "63" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Joaquín Ruiz López, Carmen Zaragoza Zaragoza, Judith Parra Chiclano, Ana Carrión Tomas, Clara Llopis Torremocha, Juan Jesús Rubio García, Álvaro Gomis Martin, José Manuel Ramia" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Joaquín" "apellidos" => "Ruiz López" "email" => array:1 [ 0 => "joaquin.ruilop@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Carmen" "apellidos" => "Zaragoza Zaragoza" ] 2 => array:2 [ "nombre" => "Judith" "apellidos" => "Parra Chiclano" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "Carrión Tomas" ] 4 => array:2 [ "nombre" => "Clara" "apellidos" => "Llopis Torremocha" ] 5 => array:2 [ "nombre" => "Juan Jesús" "apellidos" => "Rubio García" ] 6 => array:2 [ "nombre" => "Álvaro" "apellidos" => "Gomis Martin" ] 7 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Ramia" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿La endometriosis de la pared abdominal es siempre una enfermedad benigna?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1941 "Ancho" => 2508 "Tamanyo" => 228348 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0250" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Follow-up CT scan.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Endometriosis is one of the most frequent gynecological pathologies in women of reproductive age. It is characterized by the presence of epithelium and stromal cells in extrauterine locations.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Its prevalence is 10%–15%, and the average age is 30 years. Symptoms include chronic pain and infertility. The most frequent pelvic locations are the ovaries and the pelvic peritoneum.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> A rare form is endometriosis of the abdominal wall, which is most frequently found in patients with previous gynecological surgeries. The risk of malignant disease is very rare, and the most frequent variant is clear-cell adenocarcinoma.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present 2 cases derived from foci of endometriosis.<span class="elsevierStyleEnunciation" id="enun0005"><span class="elsevierStyleLabel">Case 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">The patient is a 54-year-old woman with a history of lymphoma in remission. She had undergone 2 cesarean sections, the last one 21 years earlier. Presently, she consulted for a mass in the abdominal wall. On examination, an immobile mass was palpable in the region of the cesarean section scar.</p></span></p><p id="par0020" class="elsevierStylePara elsevierViewall">CT scan revealed a 46-mm mass with heterogeneous uptake (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), with no plane of separation from the abdominal wall.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Core-needle biopsy was performed, and the results identified adenocarcinoma of possible Müllerian origin (ovarian serous).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The surgical procedure included <span class="elsevierStyleItalic">en bloc</span> excision of the tumor preserving the peritoneum and including skin, fascia, and muscles. Free margins were confirmed intraoperatively. Subsequently, the gynecology team performed a hysterectomy with double adnexectomy. The peritoneum was closed with 2/0 poly(4-hydroxybutyrate) suture. Bilateral TAR was performed, placing a 20 × 20 cm double-layered polypropylene and PVDF mesh in the preperitoneal position. A 15 × 15 cm PLP inlay mesh was placed and affixed with continuous absorbable 2/0 suture to the anterior sheath of the rectus and the greater oblique muscles.</p><p id="par0035" class="elsevierStylePara elsevierViewall">During the postoperative period, the patient presented no complications and was discharged after 4 days.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The pathology study of the surgical piece reported grade III clear-cell carcinoma. Adjuvant chemotherapy with carboplatin and paclitaxel was administered for 6 cycles.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The 6-month follow-up CT scan described post-surgical changes in the hypogastrium and RIF (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). At the one-year follow-up, the patient remains in remission.<span class="elsevierStyleEnunciation" id="enun0010"><span class="elsevierStyleLabel">Case 2</span><p id="par0050" class="elsevierStylePara elsevierViewall">The patient is a 51-year-old woman who underwent a cesarean section 25 years earlier, with no other history of interest. Presently, she consulted for a painful mass in the abdominal wall. On examination, an indurated nodule was palpated in the hypogastrium, which could not be reduced and was painful.</p></span></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">CT scan demonstrated a tumor with a solid appearance and heterogeneous density located in the left anterior rectus muscle measuring 4.8 × 2.9 × 4.6 cm. The findings were compatible with desmoid tumor, fibromatosis, endometrioma, sarcoma, etc.</p><p id="par0060" class="elsevierStylePara elsevierViewall">We performed surgery for the abdominal wall mass, using a surgical technique similar to the aforementioned case. The pathology study reported immunohistochemical findings of Müllerian origin of the neoplasm and a histology of clear-cell carcinoma. Given these results, the case was presented to the multidisciplinary team, who decided that the surgery should be completed with total hysterectomy and bilateral adnexectomy. This was followed by chemotherapy with carboplatin and paclitaxel for 6 cycles.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The patient remains under follow-up in the outpatient oncology consultations, and 2 years after the intervention she remains in remission.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Endometriosis is a benign disease with an unpredictable evolution that can infiltrate and spread to other structures.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Surgical scars are a good substrate for the implantation of endometriosis foci. As indicated by Mara et al, less than 1% of these foci will develop cancer. Yoahua et al indicate that hyperestrogenism is one of the main risk factors. The CD10 and P53 markers are important, having high sensitivity and specificity for extragonadal endometriosis and endometriosis-associated cancer, respectively.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The most frequent variant in wall tumors secondary to endometriosis is clear-cell tumors, as observed in the 2 cases described.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The interval between the first surgery and the diagnosis of carcinoma is about 20 years. Diagnoses are usually made when the patient consults for a palpable lesion in the abdomen as well as abdominal pain associated with menstruation. It is essential to use imaging studies for diagnosis (ultrasound, MRI, or CT) to define not only its size but also its relationship with neighboring structures and its resectability. Core-needle biopsy is the most cost-effective means for the initial diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The most widespread therapeutic strategy is resection of the tumor with hysterectomy and double adnexectomy.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Prognostic factors have not yet been determined due to the small number of cases, but it seems that a size greater than 5 cm, affected lymph nodes, or positive resection margins are associated with lower survival.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The article by Taburaix et al has reported a median survival of 30 months. The behavior of recurrences and/or metastases is also unknown, although the most frequent site is the inguinal lymph nodes.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Abdominal wall endometriosis is a frequently benign pathology that can sometimes become malignant, and the histological type is usually an endometrial carcinoma. In these cases, as in our patients, the histological variant is clear-cell carcinoma, which is extremely rare. Complete excision with negative margins is the objective for treatment, although this may require complex reconstructions of the abdominal wall associated with hysterectomy and adjuvant treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1509 "Ancho" => 2508 "Tamanyo" => 305777 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0245" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal CT with contrast.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1941 "Ancho" => 2508 "Tamanyo" => 228348 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0250" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Follow-up CT scan.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clear-cell carcinoma originating from cesarean section scar: Two case reports" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.R. 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Journal Information
Vol. 102. Issue 1.
Pages 61-63 (January 2024)
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Vol. 102. Issue 1.
Pages 61-63 (January 2024)
Scientific letter
Is abdominal wall endometriosis always a benign pathology?
¿La endometriosis de la pared abdominal es siempre una enfermedad benigna?
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Joaquín Ruiz López
, Carmen Zaragoza Zaragoza, Judith Parra Chiclano, Ana Carrión Tomas, Clara Llopis Torremocha, Juan Jesús Rubio García, Álvaro Gomis Martin, José Manuel Ramia
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Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
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