RESUMO
ABSTRACT BACKGROUND: Malignant transformation of endometriosis in the abdominal wall is a rare and still poorly understood event. Less than 30 cases have been reported in the worldwide literature. Most cases of solid tumors are report in a previous abdominal scar with malignant transformation of a focus of endometriosis. Presence of lymph node metastases in nearby chains is frequent and is associated with poor prognosis. CASE REPORT: We report a case of a 42-year-old woman with a history of abdominal surgery (Pfannenstiel) to resect abdominal wall endometriosis. Physical examination revealed a solid mass of approximately 10 cm x 6 cm in the anterior wall of the abdomen. Computed tomography (CT) of the abdomen and pelvis showed a heterogeneous, predominantly hypoattenuating expansive formation measuring 10.6 cm x 4.7 cm x 8.3 cm. The patient underwent exploratory incisional laparotomy, block resection of the abdominal mass and lymphadenectomy of the external and inguinal iliac chains. The abdominal wall was reconstructed using a semi-absorbable tissue-separating screen to reconstitute the defect caused by resection of the tumor. Histological evaluation revealed infiltration by malignant epithelioid neoplasia, thus confirming the immunohistochemical profile of adenocarcinoma with clear cell components. Lymphadenectomy showed metastatic involvement of an external iliac chain lymph node. CONCLUSION: Resection of the mass along with the abdominal wall, with wall margins, is the most effective treatment. Reconstruction is a challenge for surgeons. The patient has been followed up postoperatively for eight months, without any evidence of disease to date.
Assuntos
Humanos , Feminino , Adulto , Transformação Celular Neoplásica/patologia , Adenocarcinoma de Células Claras/etiologia , Endometriose/complicações , Metástase Linfática/patologia , Neoplasias Abdominais/etiologia , Tomografia Computadorizada por Raios X , Adenocarcinoma de Células Claras/cirurgia , Adenocarcinoma de Células Claras/patologia , Terapia Neoadjuvante , Parede Abdominal/cirurgia , Excisão de Linfonodo , Neoplasias Abdominais/cirurgia , Neoplasias Abdominais/patologiaRESUMO
RESUMO A transformação maligna de endometriose na parede abdominal é um evento raro e ainda pouco compreendido. Menos de 30 casos foram relatados na literatura mundial. Grande parte desses tumores é encontrada em cicatriz abdominal prévia para ressecção de focos de endometriose. A presença de metástase linfonodal é frequente e confere um prognóstico ruim. Palavras-chave: Endometriose, Parede abdominal, Transformação celular, neoplásica. Adenocarcinoma, células claras.