Endometriosis-associated malignant transformation in abdominal surgical scar: A PRISMA-compliant systematic review
Open accessAbstract
BACKGROUND: Endometriosis-associated malignant transformation in abdominal surgical scar (EAMTAS) is a very rare and aggressive phenomenon. Our current article aims to provide a clinical overview, focusing on risk factors affecting survival. METHODS: We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review based on prior reviews and case reports regarding the phenomenon published as abstracts in English, from January 1980 to November 2016. Overall, we identified 47 cases, and we included another case from our institution. We further contacted previous investigators to receive updated follow-up regarding their patients. We analyzed the data, focusing on risk factors that might affect overall survival. RESULTS: All the patients reported in the literature had a uterine surgery, mainly caesarean section. The median time-lag from first surgery to the diagnosis of cancer was about 19 years. Clear-cell carcinoma (CCC) was the most prevalent histology (67%), followed by endometrioid adenocarcinoma (15%). Most of the patients were treated by extensive surgery and chemotherapy and/or radiation. Overall 5 years survival was about 40%. Median overall survival was 42 months (95% confidence interval of [18.7, 65.3]). Although our review is currently the largest in the literature, we cannot draw any statistical significant results due to the limited number of patients reported. According to univariate Cox-regression models, a tendency toward worse prognosis was shown for 3-year disease-free survival clear cell histologic-type (P = .169), and tumor diameter ≥8 cm in nonclear-cell histology, 18 months postdiagnosis (P = .06). CONCLUSION: EAMTAS is a rare and aggressive disease. It is mostly related to cesarean section scars and is diagnosed many years postsurgery. Clear-cell histology tends to endure from the worse prognosis. The treatment is mainly extensive surgery and adjuvant chemotherapy and/or radiotherapy.
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Cesarean section endometriosis can be caused by iatrogenic deposition of endometrial cells, glands, and stroma during surgery.
“Cesarean section endometriosis (CSE) can be caused by the iatrogenic deposition of endometrial cells, glands, and stroma during any time of the surgical procedure.”
From Cesarean Section: A Potential and Forgotten Risk for Abdominal Wall Endometriosis (2021) · cites this paper as [3]
The Introduction explains scar endometriosis as iatrogenic transplantation of endometrial tissue to the wound edge during surgery, and defines endometriosis as endometrial glands and stroma outside the uterus. It says this can occur during any surgical procedure, but does not establish the citing sentence’s more specific claim that deposition can occur at any time within a procedure. (LLM, conf=0.82)
Experimental — accuracy not yet measuredClear cell carcinoma is the most commonly found histology in endometriosis-associated malignant transformation, followed by endometrioid carcinoma.
“Clear cell carcinoma histology is the most commonly found, followed by endometrioid carcinoma [3].”
From Cesarean Section: A Potential and Forgotten Risk for Abdominal Wall Endometriosis (2021) · cites this paper as [3]
Clear cell carcinoma arising from endometriotic scars tends to have poor outcomes compared to non-CCC tumors.
“and it tends to have poor outcomes compared to non-CCC tumors [3].”
From Cesarean Section: A Potential and Forgotten Risk for Abdominal Wall Endometriosis (2021) · cites this paper as [3]
The 5-year survival rate calculated by Mihailovici et al. (2017) is 40% with a median survival time after diagnosis of 42 months.
“The 5-year survival rate calculated by Mihailovici et al. (2017) is 40% with a median survival time after diagnosis of 42 months [9].”
From Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review (2024) · cites this paper as [9]
The average time between initial surgery and diagnosis of endometriotic malignant transformation was 19.3 years, suggesting a slow evolution of the disease.
“The average time between initial surgery and diagnosis of endometriotic malignant transformation was 19.3 years, which suggested a slow evolution of the disease.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [29]
Malignant transformation of scar endometriosis was reported to have a very poor prognosis.
“Malignant transformation of scar endometriosis was reported to have a very poor prognosis.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [29]
Clear cell carcinoma (66.7%) was the most common histological type in malignant transformation of scar endometriosis, followed by endometrioid carcinoma (14.6%).
“Regarding the histological type, clear cell carcinoma (66.7%) was the most common, followed by endometrioid carcinoma (14.6%).”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [29]
In a review of 48 cases of malignant transformation of scar endometriosis, the mean age at diagnosis was 46 years, 87.5% were associated with cesarean section, and 12.5% with open uterine surgery.
“In a review of 48 cases, the mean age at diagnosis was 46 years, 87.5% were associated with cesarean section, and 12.5% were associated with open uterine surgery.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [29]
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- Authors
- Mihailovici, A., Rottenstreich, M., Kovel, S., Wassermann, I., Smorgick, N., & Vaknin, Z.
- Affiliations
- Tel Aviv University (IL)
- Hebrew University of Jerusalem (IL)
- Corresponding author
- Vaknin, Zvi
- Venue
- Medicine
- Published
- 2017-12
- Volume
- 96
- Issue
- 49
- Pages
- e9136
- ISSN
- 0025-7974 (ISSN-L)
- PMC
- PMC5728970
- OpenAlex
- W2772449900
- Cited by
- 56
- References
- 53
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 6 · 2023: 2 · 2022: 5 · 2021: 13 · 2020: 8 · 2019: 5 · 2018: 8
- FWCI
- 0.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Medicine (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Health Sciences › Medicine › Reproductive Medicine › Ovarian cancer diagnosis and treatment
- Keywords
- clear cell carcinoma, endometrioid carcinoma, cesarean section, uterine surgery, overall survival, prognosis, tumor diameter, disease-free survival, adjuvant chemotherapy, radiotherapy
- MeSH terms
- Cesarean Section, Cicatrix, Female, Humans, Ovarian Neoplasms, Risk Factors, Gynecologic Surgical Procedures, Uterus, Survival Analysis, Carcinoma, Endometrioid
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