- Email: [email protected]
Clear Cell Carcinoma Arising in Extragonadal Endometriosis in a Caeserean Section Scar during Pregnancy
Gynecologic Oncology 73, 337–339 (1999) All articles available online at http://www.idealibrary.com on
LETTERS TO THE EDITOR Clear Cell Carcinoma Arising in Extragonadal Endometriosis in a Caeserean Section Scar during Pregnancy radiotherapy, and high-dose progesterone who also died of disease after 18 months. These reports suggest that malignancies arising in scar endometriosis may have a poor prognosis. Altogether, five patients with malignancy arising in scar endometriosis (four with clear cell carcinoma and one with endometroid carcinoma) have been reported in the world literature, and three of them have died of the disease.
To the Editor: We read with interest the article by Miller et al. [1] on clear cell carcinoma arising in extragonadal endometriosis in a Caesarean section scar during pregnancy. Clear cell carcinoma arising within extragonadal endometriosis during pregnancy has been reported previously [2], but not in a cesarean section scar. Two of the total eight cases mentioned in the article (seven from a review of the literature and one new one) had clear cell carcinoma arising in “scar endometriosis.” We wish to point out two additional case reports on clear cell carcinoma arising in scar endometriosis [2, 3]. Furthermore, although Miller et al. found no other histologic diagnoses than clear cell carcinoma, we have reported a patient with endometroid carcinoma arising in Caesarean section scar endometriosis [4]. The patient reported by Miller et al. had a favorable outcome after surgery, cytotoxic chemotherapy, and whole pelvic radiotherapy. However, our patient with endometroid carcinoma arising within a Caesarean section scar endometriosis developed local, intraabdominal, and bone recurrence 13 months after the diagnosis. Primary therapy in our patient consisted of complete surgical resection, six courses of chemotherapy (carboplatin and cyclophosphamide), and adjuvant medroxyprogesterone acetate (200 mg/daily), followed by radiotherapy (60 Gy to the suprapubic region). Despite second line chemotherapy (gemcitabine and mitoxantrone), our patient died of disease 20 months after the initial diagnosis. Similarly, Schnieber and Wagner-Kolb [3] reported a patient treated with surgery,
REFERENCES 1. Miller DM, Schouls JJ, Ehlen TG: Clear cell carcinoma arising in extragonadal endometriosis in a Caesarean section scar during pregnancy. Gynecol Oncol 70:127–130, 1998 2. Hitti IF, Glasberg SS, Lubicz S: Clear cell carcinoma arising in extraovarian endometriosis: Report of three cases and review of the literature. Gynecol Oncol 39:314 –320, 1990 3. Schnieber D, Wagner-Kolb D: Maligne Entartung einer extragenitalen Endometriose. Geburtsh Frauenheilk 46:658 – 659, 1986 4. Gu¨cer F, Reich O, Ko¨metter R, Pieber D: Endometroid carcinoma arising within a scar endometriosis
Fatih Gu¨cer, M.D.* Doris Pieber, M.D.† *Department of Obstetrics and Gynecology Medical School of Trakya University 22030 Edirne, Turkey †Department of Obstetrics and Gynecology University of Graz Auenbruggerplatz 14 A-8036 Graz, Austria Article ID gyno.1999.5389
Reply To the Editor: Clear cell carcinoma arising in extragonadal endometriosis in a Caesarean scar during pregnancy is a rare occurrence. It appears that at the time of our review of the literature the Medline database was not yet updated to include the article by Gucer et al. [1]. (The article was published around the time of submission of our paper in February of 1997). Gucer and Pieber suggest that patients presenting with
malignant transformation of endometriotic deposits in surgical scars do poorly [2]. Clear cell carcinoma generally presents as a high-grade tumor. As in epithelial ovarian carcinoma, high-grade features of the tumor would be expected to confer poor prognosis. Given the small number of cases reported to date, the conclusion that it is the localization (in scar tissue) of the tumor independent of the tumor grade that confers poor prognosis may need to await the long-term follow-up of a larger number of patients. The
337
0090-8258/99 $30.00 Copyright © 1999 by Academic Press All rights of reproduction in any form reserved.
LETTERS TO THE EDITOR Clear Cell Carcinoma Arising in Extragonadal Endometriosis in a Caeserean Section Scar during Pregnancy radiotherapy, and high-dose progesterone who also died of disease after 18 months. These reports suggest that malignancies arising in scar endometriosis may have a poor prognosis. Altogether, five patients with malignancy arising in scar endometriosis (four with clear cell carcinoma and one with endometroid carcinoma) have been reported in the world literature, and three of them have died of the disease.
To the Editor: We read with interest the article by Miller et al. [1] on clear cell carcinoma arising in extragonadal endometriosis in a Caesarean section scar during pregnancy. Clear cell carcinoma arising within extragonadal endometriosis during pregnancy has been reported previously [2], but not in a cesarean section scar. Two of the total eight cases mentioned in the article (seven from a review of the literature and one new one) had clear cell carcinoma arising in “scar endometriosis.” We wish to point out two additional case reports on clear cell carcinoma arising in scar endometriosis [2, 3]. Furthermore, although Miller et al. found no other histologic diagnoses than clear cell carcinoma, we have reported a patient with endometroid carcinoma arising in Caesarean section scar endometriosis [4]. The patient reported by Miller et al. had a favorable outcome after surgery, cytotoxic chemotherapy, and whole pelvic radiotherapy. However, our patient with endometroid carcinoma arising within a Caesarean section scar endometriosis developed local, intraabdominal, and bone recurrence 13 months after the diagnosis. Primary therapy in our patient consisted of complete surgical resection, six courses of chemotherapy (carboplatin and cyclophosphamide), and adjuvant medroxyprogesterone acetate (200 mg/daily), followed by radiotherapy (60 Gy to the suprapubic region). Despite second line chemotherapy (gemcitabine and mitoxantrone), our patient died of disease 20 months after the initial diagnosis. Similarly, Schnieber and Wagner-Kolb [3] reported a patient treated with surgery,
REFERENCES 1. Miller DM, Schouls JJ, Ehlen TG: Clear cell carcinoma arising in extragonadal endometriosis in a Caesarean section scar during pregnancy. Gynecol Oncol 70:127–130, 1998 2. Hitti IF, Glasberg SS, Lubicz S: Clear cell carcinoma arising in extraovarian endometriosis: Report of three cases and review of the literature. Gynecol Oncol 39:314 –320, 1990 3. Schnieber D, Wagner-Kolb D: Maligne Entartung einer extragenitalen Endometriose. Geburtsh Frauenheilk 46:658 – 659, 1986 4. Gu¨cer F, Reich O, Ko¨metter R, Pieber D: Endometroid carcinoma arising within a scar endometriosis
Fatih Gu¨cer, M.D.* Doris Pieber, M.D.† *Department of Obstetrics and Gynecology Medical School of Trakya University 22030 Edirne, Turkey †Department of Obstetrics and Gynecology University of Graz Auenbruggerplatz 14 A-8036 Graz, Austria Article ID gyno.1999.5389
Reply To the Editor: Clear cell carcinoma arising in extragonadal endometriosis in a Caesarean scar during pregnancy is a rare occurrence. It appears that at the time of our review of the literature the Medline database was not yet updated to include the article by Gucer et al. [1]. (The article was published around the time of submission of our paper in February of 1997). Gucer and Pieber suggest that patients presenting with
malignant transformation of endometriotic deposits in surgical scars do poorly [2]. Clear cell carcinoma generally presents as a high-grade tumor. As in epithelial ovarian carcinoma, high-grade features of the tumor would be expected to confer poor prognosis. Given the small number of cases reported to date, the conclusion that it is the localization (in scar tissue) of the tumor independent of the tumor grade that confers poor prognosis may need to await the long-term follow-up of a larger number of patients. The
337
0090-8258/99 $30.00 Copyright © 1999 by Academic Press All rights of reproduction in any form reserved.