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Cited by 22Endometriosis Research and TreatmentEndometrial and Cervical Cancer TreatmentsMetastasis and carcinoma case studies

Clear cell carcinoma arising from abdominal wall endometriosis—A report on two cases and literature review

Open access
Bahall, Vishal, De Barry, Lance, Rampersad, Arlene·2022·World Journal of Surgical Oncology
DOI 10.1186/s12957-022-02553-xPMC PMC8922864

Published version of a preprint

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Abstract

Background: Malignant transformation of abdominal wall endometriosis is extremely rare. Clear cell carcinoma and endometrioid carcinoma are the two most prevalent histological subtypes of malignant endometriosis. To date, approximately, thirty cases of clear cell carcinoma arising from abdominal wall endometriosis have been described worldwide. Case presentation: We report two cases of clear cell carcinoma developing postoperatively in the anterior abdominal wall in women with a history of extensive endometriosis. Histopathology of the resected abdominal wall tumor demonstrated benign endometriosis contiguous with features of clear cell carcinoma. These histological features satisfied Sampson’s criteria which are required for diagnosing malignant endometriosis. Both patients were successfully managed with platinum-based adjuvant chemotherapy following cytoreductive surgery. Conclusion: Clear cell carcinoma arising from the abdominal wall endometriosis is a rare, highly aggressive cancer with a propensity to recur or metastasize. Due to the limited publications on this clinical entity, there are no clearly established protocols regarding adjuvant treatment, and an evaluation of prognostic factors is lacking. Clinicians must have a high index of suspicion for malignant endometriosis of the abdominal wall, particularly in patients with an abdominal wall mass, prior abdominal surgery, and long-standing endometriosis. By presenting our case, we expect to raise awareness and study of this rare endometriosis-related neoplasm.

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Written from the paper’s full text.

TL;DR

This case report and literature review describes two women with clear cell carcinoma arising from abdominal wall endometriosis after long-standing endometriosis and prior abdominal surgery. Both underwent cytoreductive surgery and platinum-based adjuvant chemotherapy; one remained recurrence-free at 32 months, while the other developed lymph node recurrence.

Key findings

Both cases fulfilled Sampson’s three criteria and Scott’s fourth criterion for endometriosis-related malignancy: benign endometriosis contiguous with clear cell carcinoma, no other primary site, and histology consistent with endometrial origin.

  • Case 1: a 46-year-old nulliparous woman with 15-year endometriosis and a 10 cm × 8 cm suprapubic mass; histopathology showed clear cell carcinoma with a 1-mm clear margin and negative lymph nodes. After six cycles of paclitaxel 135 mg/m² plus carboplatin AUC-6, CA-125 normalized, and she had no recurrence 32 months after treatment.
  • Case 2: a 57-year-old woman with 20-year endometriosis and a 15 cm × 15 cm abdominal wall mass; eight abdominal wall lymph nodes were positive for metastasis. After six cycles of paclitaxel 135 mg/m² plus carboplatin AUC-5, PET showed recurrent FDG-avid pelvic and inguinal nodes, with the right para-iliac node having SUVmax 10.9; she underwent lymph node dissection and continued adjuvant chemotherapy.
  • The review states malignant transformation of endometriosis occurs in approximately 0.7–1.0% of women with endometriosis; when malignant endometriosis involves the abdominal wall, clear cell carcinoma is the predominant subtype (66%), followed by endometrioid carcinoma (24%), and median survival is approximately 30 months according to Taburiaux.

Methods

Case report and literature review of two patients with clear cell carcinoma arising from abdominal wall endometriosis, using clinical examination, CT/PET imaging, histopathology, immunohistochemistry, surgical findings, treatment, and follow-up.

  • Diagnosis was assessed against Sampson’s criteria and Scott’s fourth criterion; immunohistochemistry included CK7, CK20, ER, p53, WT-1, and PAX8.
  • Management consisted of cytoreductive surgery—abdominal wall mass resection, hysterectomy, bilateral salpingo-oophorectomy, lymph node sampling/dissection, and polypropylene mesh reconstruction—plus adjuvant paclitaxel/carboplatin and CA-125 monitoring.

Limitations

The paper states that publications on this clinical entity are limited, there are no clearly established protocols regarding adjuvant treatment, and evaluation of prognostic factors is lacking.

  • Evident from the text: conclusions are based on only two cases and a narrative literature review, without systematic review methodology or comparative data.
  • Follow-up differs between cases—32 months for Case 1 and ongoing treatment for Case 2—which limits generalizability.

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Integrity signals

Registry

Crossref · 10.1186/s12957-022-02553-x

Cites

28 of 28 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 52 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    Both patients were successfully managed with platinum-based adjuvant chemotherapy following cytoreductive surgery.

    “Both patients were successfully managed with platinum-based adjuvant chemotherapy following cytoreductive surgery.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Histopathology of the resected abdominal wall tumor demonstrated benign endometriosis contiguous with features of clear cell carcinoma.

    “Histopathology of the resected abdominal wall tumor demonstrated benign endometriosis contiguous with features of clear cell carcinoma.”
    Quote in the paperSubstantial claim
  • Findingown data

    One patient developed recurrence in the inguinal and pelvic lymph nodes which necessitated lymph node dissection and further chemotherapy.

    “One patient developed recurrence in the inguinal and pelvic lymph nodes which necessitated lymph node dissection and further chemotherapy.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Histopathology in Case 2 indicated that the abdominal wall mass was a clear cell carcinoma with a prominent tubulopapillary pattern.

    “Histopathology (Fig. 3B) indicated that the abdominal wall mass was a clear cell carcinoma with a prominent tubulopapillary pattern.”
    Quote in the paperSubstantial claim
  • Findingown data

    Histopathology of the abdominal wall mass in Case 1 indicated clear cell carcinoma associated with a solid, acinar pattern, and a 1-mm clear margin.

    “Histopathology of the abdominal wall mass indicated clear cell carcinoma associated with a solid, acinar pattern, and a 1-mm clear margin.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 25
  • May combine two claims. 21

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient in Case 2 had a 20-year history of endometriosis.

    “She is a known diabetic and hypertensive with a 20-year history of endometriosis.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The patients' reported histories of long-standing endometriosis are accurate.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient in Case 1 had a history of endometriosis for 15 years.

    “She had a history of endometriosis for 15 years, and her past surgical history is significant for laparoscopic ovarian drilling 10 years prior.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The patients' reported histories of long-standing endometriosis are accurate.

  • May combine two claims.

    Findingown data

    After completion of six cycles of chemotherapy in Case 2, CT imaging demonstrated localized disease in the pelvic and inguinal lymph nodes, confirmed as new areas of involvement.

    “However, after the completion of six cycles of chemotherapy, CT imaging demonstrated localized disease in the pelvic and inguinal lymph nodes. These lesions were confirmed to be new areas of involvement when compared to pre-surgical imaging.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The patient in Case 1 is now 32 months since her treatment concluded and is currently followed up with no evidence of recurrence.

    “The patient is now 32 months since her treatment concluded and is currently followed up in both Gynae-Oncology and Medical Oncology clinics with no evidence of recurrence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The management of clear cell carcinoma of the abdominal wall necessitates cytoreductive surgery with considerations for adjuvant platinum-based chemotherapy.

    “The management of clear cell carcinoma of the abdominal wall necessitates cyto reductive surgery with considerations for adjuvant platinum-based chemotherapy [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Bats AS, Zafrani Y, Pautier P, Duvillard P, Morice P. Malignant transformation of abdominal wall endometriosis to clear cell carcinoma: case report and review of the literature. Fertil Steril. 2008;90(4):1197.e13–6. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Malignant transformation of endometriotic lesions carries a 0.7-1.0% incidence rate.

    “malignant transformation of endometriotic lesions is rare and carries a 0.7–1.0% incidence rate [2].”
    • Also stated in: § Discussion · plain
      “approximately 0.7–1.0% of women diagnosed with endometriosis develop an endometriosis-related neoplasm [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Lauslahti K. Malignant external endometriosis. A case of adenocarcinoma of umbilical endometriosis. Acta Pathol Microbiol Scand Suppl. 1972;233:98–102.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Abdominal wall endometriosis typically occurs following cesarean section, hysterectomy, laparoscopic trocar placement, episiotomy, and hernia repair.

    “The abdominal wall is a common site of extraperitoneal endometriosis, and it typically occurs following the cesarean section, hysterectomy, laparoscopic trocar placement, episiotomy, and hernia repair [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Bektaş H, Bilsel Y, Sari YS, Ersöz F, Koç O, Deniz M, et al. Abdominal wall endometrioma; a 10-year experience and brief review of the literature. J Surg Res. 2010;164(1):e77–81. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Due to limited publications on clear cell carcinoma arising from abdominal wall endometriosis, there are no clearly established protocols regarding adjuvant treatment, and an evaluation of prognostic factors is lacking.

    “Due to the limited publications on this clinical entity, there are no clearly established protocols regarding adjuvant treatment, and an evaluation of prognostic factors is lacking.”
    • Also stated in: § Discussion · plain
      “Due to the limited publications on this clinical entity, there are no clearly established protocols regarding adjuvant treatment [7].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Lai Y-L, Hsu H-C, Kuo K-T, Chen Y-L, Chen C-A, Cheng W-F. Clear cell carcinoma of the abdominal wall as a rare complication of general obstetric and gynecologic surgeries: 15 years of experience at a large academic institution. Int J Environ Res Public Health. 2019;16(4):552. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The abdominal wall is a common site of extraperitoneal endometriosis.

    “The abdominal wall is a common site of extraperitoneal endometriosis, and it typically occurs following the cesarean section, hysterectomy, laparoscopic trocar placement, episiotomy, and hernia repair [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Bektaş H, Bilsel Y, Sari YS, Ersöz F, Koç O, Deniz M, et al. Abdominal wall endometrioma; a 10-year experience and brief review of the literature. J Surg Res. 2010;164(1):e77–81. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Malignant endometriosis of the abdominal wall occurs in patients with an abdominal wall mass, prior abdominal surgery, and long-standing endometriosis.

    “Clinicians must have a high index of suspicion for malignant endometriosis of the abdominal wall, particularly in patients with an abdominal wall mass, prior abdominal surgery, and long-standing endometriosis.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Sampson defined three criteria for diagnosing an endometriosis-related neoplasm: evidence of endometriosis in proximity to the tumor, absence of another primary site tumor, and histological evidence consistent with an endometrial origin.

    “Sampson et al. defined three criteria for diagnosing an endometriosis-related neoplasm: (1) evidence of endometriosis in proximity to the tumor, (2) absence of another primary site tumor, and (3) histological evidence consistent with an endometrial origin [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Sampson JA. Endometrial carcinoma of the ovary, arising in endometrial tissue in that organ. Arch Surg. 1925;10(1):1–72. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Approximately thirty cases of clear cell carcinoma arising from abdominal wall endometriosis have been described worldwide.

    “To date, approximately, thirty cases of clear cell carcinoma arising from abdominal wall endometriosis have been described worldwide.”
    • Also stated in: § Discussion · plain
      “Approximately thirty cases have been described worldwide since it was first reported by Sampson in 1925 [8].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Giannella L, Serri M, Maccaroni E, Di Giuseppe J, Carpini GD, Berardi R, et al. Endometriosis-associated clear cell carcinoma of the abdominal wall after caesarean section: a case report and review of the literature. In Vivo (Athens, Greece). 2020;34(4):2147–52.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The prognosis of clear cell carcinoma of the abdominal wall is poor as disease recurrence or progression is common.

    “Clear cell carcinoma of the abdominal wall is associated with a poor prognosis [12].”
    • Also stated in: § Discussion · plain
      “Patients often encounter disease recurrence or progression.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Gadducci A, Cosio S, Spirito N, Cionini L. Clear cell carcinoma of the endometrium: a biological and clinical enigma. Anticancer Res. 2010;30(4):1327–34.

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Clear cell carcinoma arising from abdominal wall endometriosis is a rare, highly aggressive cancer with a propensity to recur or metastasize.

    “Clear cell carcinoma arising from the abdominal wall endometriosis is a rare, highly aggressive cancer with a propensity to recur or metastasize.”
    • Also stated in: § Discussion · plain
      “Clear cell carcinoma arising from abdominal wall endometriosis is a highly aggressive, rare cancer with a propensity to recur or metastasize [7].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Lai Y-L, Hsu H-C, Kuo K-T, Chen Y-L, Chen C-A, Cheng W-F. Clear cell carcinoma of the abdominal wall as a rare complication of general obstetric and gynecologic surgeries: 15 years of experience at a large academic institution. Int J Environ Res Public Health. 2019;16(4):552. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Clear cell carcinoma and endometrioid carcinoma are the two most prevalent histological subtypes of malignant endometriosis.

    “Clear cell carcinoma and endometrioid carcinoma are the two most prevalent histological subtypes of malignant endometriosis.”
    • Also stated in: § Introduction · plain
      “Clear cell carcinoma is the most common histologic subtype of malignant endometriosis, followed by endometrioid cancer [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Stern RC, Dash R, Bentley RC, Snyder MJ, Haney AF, Robboy SJ. Malignancy in endometriosis: frequency and comparison of ovarian and extraovarian types. Int J Gynecol Pathol. 2001;20(2):133–9. https://doi.org/10.1097/00004347-200104000-00004. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Malignant endometriosis typically affects the ovary while extra-gonadal malignant endometriosis may involve the colon, rectovaginal septum, and vaginal walls.

    “Malignant endometriosis typically affects the ovary while, extra-gonadal malignant endometriosis may involve the colon, rectovaginal septum, and vaginal walls [10, 11].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10] Benoit L, Arnould L, Cheynel N, Diane B, Causeret S, Machado A, Collin F, Fraisse J, Cuisenier J. Malignant extraovarian endometriosis: a review. Eur J Surg Oncol. 2006;32(1):6–11. https://doi.org/10.1016/j.ejso.2005.08.011. source

      Not checked in the free run.

    • cites [11] Inoue N, Hirakawa T, Mitsushita J, Kitahara Y, Iwase A. Malignancies associated with extraovarian endometriosis: a literature review. Endocrines. 2021;2(3):251–65. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Malignant transformation of abdominal wall endometriosis develops 21 years after initial uterine surgery, while the average age at diagnosis is 47 years.

    “According to Taburiaux et al., malignant transformation of the abdominal wall endometriosis develops 21 years after initial uterine surgery, while the average age at diagnosis is 47 years [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Taburiaux L, Pluchino N, Petignat P, Wenger JM. Endometriosis-associated abdominal wall cancer: a poor prognosis? Int J Gynecol Cancer. 2015;25(9):1633–8. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The pathogenesis of malignant transformation of endometriosis remains unelucidated; however, certain studies implicate oxidative stress according to a two-step process in endometriotic carcinogenesis.

    “The pathogenesis of malignant transformation of endometriosis remains unelucidated; however, certain studies implicate oxidative stress according to a two-step process in endometriotic carcinogenesis [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Scutiero G, Iannone P, Bernardi G, Bonaccorsi G, Spadaro S, Volta CA, et al. Oxidative stress and endometriosis: a systematic review of the literature. Oxid Med Cell Longev. 2017;2017:7265238. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Carcinogens like dioxin, and genetic anomalies involving the loss of heterozygosity on chromosome 4, may be implicated in malignant transformation of endometriosis.

    “Additionally, carcinogens like dioxin, and genetic anomalies involving the loss of heterozygosity on chromosome 4, may be implicated [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Benoit L, Arnould L, Cheynel N, Diane B, Causeret S, Machado A, Collin F, Fraisse J, Cuisenier J. Malignant extraovarian endometriosis: a review. Eur J Surg Oncol. 2006;32(1):6–11. https://doi.org/10.1016/j.ejso.2005.08.011. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Clear cell carcinomas of the endometrium, ovary, vagina, and cervix are deeply invasive and carry a poor prognosis.

    “These cancers are deeply invasive and carry a poor prognosis [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Gadducci A, Cosio S, Spirito N, Cionini L. Clear cell carcinoma of the endometrium: a biological and clinical enigma. Anticancer Res. 2010;30(4):1327–34.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Risk factors for malignant transformation of endometriosis include hyperestrogenism, endometriosis diagnosed at an early age, long-standing endometriosis, ovarian endometriomas, and endometriosis associated with infertility.

    “Several risk factors have been described for the malignant transformation of endometriosis. These include hyperestrogenism, endometriosis diagnosed at an early age, women with long-standing endometriosis, ovarian endometriomas, and endometriosis associated with infertility [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Nezhat F, Apostol R, Mahmoud M, el Daouk M. Malignant transformation of endometriosis and its clinical significance. Fertil Steril. 2014;102(2):342–4. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The most common histologic subtype of extra-gonadal malignant endometriosis is endometrioid carcinoma (69.1%) followed by sarcoma (25%) and clear cell carcinoma (4.5%).

    “The most common histologic subtype of extra-gonadal malignant endometriosis is endometrioid carcinoma (69.1%) followed by sarcoma (25%) and clear cell carcinoma (4.5%) [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Bats AS, Zafrani Y, Pautier P, Duvillard P, Morice P. Malignant transformation of abdominal wall endometriosis to clear cell carcinoma: case report and review of the literature. Fertil Steril. 2008;90(4):1197.e13–6. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The tumor often involves the rectus abdominis muscle and may protrude into the abdominal cavity as noted in the second case described.

    “The tumor often involves the rectus abdominis muscle and may protrude into the abdominal cavity as noted in the second case described [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Alberto VO, Lynch M, Labbei FN, Jeffers M. Primary abdominal wall clear cell carcinoma arising in a caesarean section scar endometriosis. Ir J Med Sci. 2006;175(1):69. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Immunohistochemistry may demonstrate positive stains for HNF-1B, Napsin-A, AMACR, CK-7, and p53 in clear cell carcinoma.

    “Moreover, immunohistochemistry may demonstrate positive stains for HNF-1B, Napsin-A, AMACR, CK-7, and p53 [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Murali R, Davidson B, Fadare O, Carlson JA, Crum CP, Gilks CB, et al. High-grade endometrial carcinomas: morphologic and immunohistochemical features, diagnostic challenges and recommendations. Int J Gynecol Pathol. 2019;38 Suppl 1(Iss 1 Suppl 1):S40–63. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Surgical intervention for clear cell carcinoma arising from abdominal wall endometriosis necessitates wide excision of the abdominal wall tumor to achieve healthy margins, hysterectomy, bilateral salpingo-oophorectomy, and abdominal wall reconstruction.

    “Surgical intervention necessitates wide excision of the abdominal wall tumor to achieve healthy margins, hysterectomy, bilateral salpingo-oophorectomy, and abdominal wall reconstruction [5, 17].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Bats AS, Zafrani Y, Pautier P, Duvillard P, Morice P. Malignant transformation of abdominal wall endometriosis to clear cell carcinoma: case report and review of the literature. Fertil Steril. 2008;90(4):1197.e13–6. source

      Not checked in the free run.

    • cites [17] Marques C, Silva TS, Dias MF. Clear cell carcinoma arising from abdominal wall endometriosis - brief report and review of the literature. Gynecol Oncol Rep. 2017;20:78–80. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Histologically, clear cell carcinoma exhibits papillary, tubulocystic, or solid patterns.

    “Histologically, clear cell carcinoma exhibits papillary, tubulocystic, or solid patterns [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Gadducci A, Cosio S, Spirito N, Cionini L. Clear cell carcinoma of the endometrium: a biological and clinical enigma. Anticancer Res. 2010;30(4):1327–34.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A bilateral salpingo-oophorectomy and endometrial biopsy should be performed to exclude other primary tumor sites.

    “According to Ferrandina et al., a bilateral salpingo-oophorectomy and endometrial biopsy should be performed to exclude other primary tumor sites [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Ferrandina G, Palluzzi E, Fanfani F, et al. Endometriosis-associated clear cell carcinoma arising in caesarean section scar: a case report and review of the literature. World J Surg Oncol. 2016;14(1):300. https://doi.org/10.1186/s12957-016-1054-7. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    In both cases described, histopathology fulfilled Sampson's three criteria and Scott's fourth criterion, thus confirming an endometriosis-related clear cell carcinoma.

    “In both cases described, histopathology fulfilled Sampson’s three criteria and Scott’s fourth criterion, thus confirming an endometriosis-related clear cell carcinoma.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Lymph node metastasis is common in clear cell carcinoma of the abdominal wall and particularly involves the inguinal lymph nodes since the superficial abdominal wall lymphatics drain towards the superficial inguinal nodes.

    “Lymph node metastasis is common and particularly involves the inguinal lymph nodes since the superficial abdominal wall lymphatics drain towards the superficial inguinal nodes [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Lengelé B, Nyssen-Behets C, Scalliet P. Anatomical bases for the radiological delineation of lymph node areas. Upper limbs, chest and abdomen. Radiother Oncol. 2007;84(3):335–47. https://doi.org/10.1016/j.radonc.2007.07.016. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Lymph node dissection is considered when pre-operative imaging demonstrates suspicious nodes or nodal involvement.

    “Lymph node dissection is considered when pre-operative imaging demonstrates suspicious nodes or nodal involvement [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Liu H, Leng J, Lang J, Cui Q. Clear cell carcinoma arising from abdominal wall endometriosis: a unique case with bladder and lymph node metastasis. World J Surg Oncol. 2014;12:51. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The cancer antigen CA-125 is a non-specific biomarker elevated in both ovarian malignancy and advanced endometriosis.

    “The cancer antigen, CA-125, is a non-specific biomarker elevated in both ovarian malignancy and advanced endometriosis [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Bats AS, Zafrani Y, Pautier P, Duvillard P, Morice P. Malignant transformation of abdominal wall endometriosis to clear cell carcinoma: case report and review of the literature. Fertil Steril. 2008;90(4):1197.e13–6. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Clear cell carcinoma arising from the malignant transformation of abdominal wall endometriosis is a rare and aggressive cancer associated with a poor prognosis.

    “In conclusion, clear cell carcinoma arising from the malignant transformation of abdominal wall endometriosis is a rare and aggressive cancer associated with a poor prognosis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A prosthetic mesh or in some cases, a pedicle-skin-muscle flap, is used for abdominal wall repair and reinforcement depending on the extent of surgical resection.

    “A prosthetic mesh or in some cases, a pedicle-skin-muscle flap, is used for abdominal wall repair and reinforcement depending on the extent of surgical resection [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Ferrandina G, Palluzzi E, Fanfani F, et al. Endometriosis-associated clear cell carcinoma arising in caesarean section scar: a case report and review of the literature. World J Surg Oncol. 2016;14(1):300. https://doi.org/10.1186/s12957-016-1054-7. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Premenopausal women may experience cyclical abdominal pain which reflects the presence of hormonally active endometriotic foci.

    “Additionally, premenopausal women may experience cyclical abdominal pain which reflects the presence of hormonally active endometriotic foci [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Hensen JH, Van Breda Vriesman AC, Puylaert JB. Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography. AJR Am J Roentgenol. 2006;186(3):616–20. https://doi.org/10.2214/AJR.04.1619. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The combination of carboplatin (AUC 5-6) and paclitaxel (175mg/m2) used for six cycles demonstrates efficacy in treatment, and this combination is better tolerated and less toxic compared to the use of doxorubicin, carboplatin, and paclitaxel triple therapy.

    “The combination of carboplatin (AUC 5-6) and paclitaxel (175mg/m2) used for six cycles demonstrates efficacy in treatment, and this combination is better tolerated and less toxic compared to the use of doxorubicin, carboplatin, and paclitaxel triple therapy [8, 25, 26].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [8] Giannella L, Serri M, Maccaroni E, Di Giuseppe J, Carpini GD, Berardi R, et al. Endometriosis-associated clear cell carcinoma of the abdominal wall after caesarean section: a case report and review of the literature. In Vivo (Athens, Greece). 2020;34(4):2147–52.

      Not checked in the free run.

    • cites [25] Olawaiye AB, Boruta DM II. Management of women with clear cell endometrial cancer: a Society of Gynecologic Oncology (SGO) review. Gynecol Oncol. 2009;113(2):277–83. source

      Not checked in the free run.

    • cites [26] Sergent F, Baron M, Le Cornec JB, Scotté M, Mace P, Marpeau L. Transformation maligne d’une endométriose pariétale: un nouveau cas. J Gynécol Obstét Biol Reprod. 2006;35(2):186–90. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Other common histologic findings of clear cell carcinoma include intraluminal mucin, intracytoplasmic vacuoles, eosinophilic hyaline mucin, and stromal hyalinization.

    “Other common histologic findings include intraluminal mucin, intracytoplasmic vacuoles, eosinophilic hyaline mucin, and stromal hyalinization [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Gadducci A, Cosio S, Spirito N, Cionini L. Clear cell carcinoma of the endometrium: a biological and clinical enigma. Anticancer Res. 2010;30(4):1327–34.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A diagnostic dilemma often arises in the evaluation of women with clear cell carcinoma of the abdominal wall; this clinical entity may be mistaken for various benign causes of an abdominal wall mass such as an abscess, hernia, lipoma, hematoma, or lymphadenopathy.

    “A diagnostic dilemma often arises in the evaluation of women with clear cell carcinoma of the abdominal wall. This clinical entity may be mistaken for various benign causes of an abdominal wall mass such as an abscess, hernia, lipoma, hematoma, or lymphadenopathy [6].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. Am J Surg. 2003;185(6):596–8. source

      Not checked in the free run.

37 of 37

  • The paper relies on this without support.

    The patients' reported histories of long-standing endometriosis are accurate.

    “She had a history of endometriosis for 15 years, and her past surgical history is significant for laparoscopic ovarian drilling 10 years prior.”
    “She is a known diabetic and hypertensive with a 20-year history of endometriosis.”

  • The paper relies on this without support.

    There are no pathognomonic biochemical markers for malignant endometriosis.

    “Currently, there are no pathognomonic biochemical markers for malignant endometriosis.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Some authors describe other prognostic factors such as the size of the mass at the time of diagnosis, which could play a role in a better outcome, especially if the masses range between 4 and 9 cm.

    “Some authors describe other prognostic factors such as the size of the mass at the time of diagnosis, which could play a role in a better outcome, especially if the masses range between 4 and 9 cm [63,64,65,66,67,68,69,70,71,72,73,74].”

    From Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review (2024) · cites this paper as [66]

    The Discussion (page unavailable) says that evaluating prognostic factors is challenging because cases are rare. The Case descriptions (page unavailable) give mass measurements, but the passages found do not link size at diagnosis—or a 4–9 cm range—to better outcomes (searched: mass size, prognosis, 4–9 cm). (LLM, conf=0.76)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

2 of the 30 references couldn’t be matched to a known paper.

Cited by

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Related

Authors
Bahall, V., De Barry, L., & Rampersad, A.
Affiliations
San Fernando General Hospital (TT)
Corresponding author
Bahall, Vishal
ORCID
Venue
World Journal of Surgical Oncology
Publisher
Springer Science and Business Media LLC
Published
2022-03-15
Volume
20
Issue
1
Pages
86-86
ISSN
1477-7819 (ISSN-L)
DOI
10.1186/s12957-022-02553-x
PMC
PMC8922864
OpenAlex
W4220877973
Semantic Scholar
770ea24b6172f9b56c79165f644e4394b4be6933
Cited by
22
References
30
Citations by year
2026: 7 · 2025: 8 · 2024: 3 · 2023: 2 · 2022: 2
FWCI
3.16
Type
journal article
Language
en
Open access
Licence
Locations
  • World Journal of Surgical Oncology (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Metastasis and carcinoma case studies
Keywords
clear cell carcinoma, abdominal wall endometriosis, malignant transformation of endometriosis, postoperative tumor, anterior abdominal wall, cytoreductive surgery, platinum-based adjuvant chemotherapy, endometrioid carcinoma
MeSH terms
Endometriosis, Female, Humans, Neoplasm Recurrence, Local, Adenocarcinoma, Clear Cell, Carcinoma, Endometrioid, Abdominal Wall

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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