腹壁子宫内膜异位症相关性透明细胞癌的诊治进展

doi:10.12280/gjfckx.20230712

摘要/Abstract

摘要：

腹壁子宫内膜异位症相关性透明细胞癌（abdominal wall endometriosis-associated clear cell carcinoma，AWECC）发病率低，侵袭性强，预后差，相关文献报道较少。AWECC多由腹壁子宫内膜异位症（abdominal wall endometriosis，AWE）恶变形成。随着剖宫产等进入宫腔的盆腔手术数量增加，AWE的发病率呈上升趋势，但其恶变机制尚不明确。AWECC缺乏特异性的临床特征，临床上易被误诊为AWE，确诊依赖于病理检查。AWECC的治疗多来源于临床医生的个人经验，差异性大，缺乏相应的指南推荐。临床上多采用以扩大腹壁肿瘤切除术为主的手术治疗，化疗和放疗能否使AWECC患者获益尚需进一步探讨。目前关于AWECC的研究多为个案报道，综合国内外文献，探讨AWECC的发病、诊断、治疗及预后，以期引起临床医生对疾病诊断的重视，为临床诊治和随访提供证据。

关键词: 腹壁子宫内膜异位症, 腹壁子宫内膜异位症相关性透明细胞癌, 诊断, 治疗, 预后

Abstract:

Abdominal wall endometriosis-associated clear cell carcinoma (AWECC) is characterized by low incidence, high invasiveness and poor prognosis. To date, there have been relatively few reports on AWECC. AWECC primarily originates from the malignant transformation of abdominal wall endometriosis (AWE). In recent years, there has been a rising incidence of AWECC, possibly attributed to the increased number of pelvic and abdominal surgeries, including cesarean section. Nevertheless, the mechanisms underlying its malignant transformation remain unclear. AWECC lacks specific clinical features, making it challenging to distinguish from benign AWE. The definitive diagnosis depends on histological examination. The treatment of AWECC primarily lies on the clinicians' personal experience, which varies greatly, and lacks corresponding guidelines. In clinical practice, surgical treatment with extended resection of the abdominal wall tumor, is typically employed. The efficacy of chemotherapy and radiotherapy in AWECC patients requires further investigation. Until now, most of the studies on AWECC have been case reports. Therefore, we reviewed the pathogenesis, diagnosis, treatment and prognosis of AWECC based on domestic and foreign literature, so as to arouse the attention of clinicians to the diagnosis of the disease and provide evidence for clinical diagnosis, treatment and follow-up.

Key words: Abdominal wall endometriosis, Abdominal wall endometriosis-associated clear cell carcinoma, Diagnosis, Therapy, Prognosis

张玮玥, 杨静, 季佳楠, 罗成燕. 腹壁子宫内膜异位症相关性透明细胞癌的诊治进展[J]. 国际妇产科学杂志, 2024, 51(1): 60-65.

ZHANG Wei-yue, YANG Jing, JI Jia-nan, LUO Cheng-yan. Research Progress on the Diagnosis and Treatment of Abdominal Wall Endometriosis-Associated Clear Cell Carcinoma[J]. Journal of International Obstetrics and Gynecology, 2024, 51(1): 60-65.

参考文献 33

[1]	Yachida N, Yoshihara K, Yamaguchi M, et al. How Does Endometriosis Lead to Ovarian Cancer? The Molecular Mechanism of Endometriosis-Associated Ovarian Cancer Development[J]. Cancers(Basel), 2021, 13(6):1439. doi: 10.3390/cancers13061439.
[2]	Giannella L, Marconi C, Di Giuseppe J, et al. Malignant Transformation of Postmenopausal Endometriosis: A Systematic Review of the Literature[J]. Cancers(Basel), 2021, 13(16):4026. doi: 10.3390/cancers13164026.
[3]	Bulun SE, Yilmaz BD, Sison C, et al. Endometriosis[J]. Endocr Rev, 2019, 40(4):1048-1079. doi: 10.1210/er.2018-00242. pmid: 30994890
[4]	Gou Y, Li X, Li P, et al. Estrogen receptor β upregulates CCL2 via NF-κB signaling in endometriotic stromal cells and recruits macrophages to promote the pathogenesis of endometriosis[J]. Hum Reprod, 2019, 34(4):646-658. doi: 10.1093/humrep/dez019.
[5]	王湘炼, 朱姝, 徐炜, 等. 子宫内膜异位症中雌、孕激素及其受体基因甲基化的研究进展[J]. 国际妇产科学杂志, 2023, 50(2):165-169. doi: 10.12280/gjfckx.20220689.
[6]	Xian H, Watari K, Sanchez-Lopez E, et al. Oxidized DNA fragments exit mitochondria via mPTP- and VDAC-dependent channels to activate NLRP3 inflammasome and interferon signaling[J]. Immunity, 2022, 55(8):1370-1385.e8. doi: 10.1016/j.immuni.2022.06.007. pmid: 35835107
[7]	Zhao H, Wu L, Yan G, et al. Inflammation and tumor progression: signaling pathways and targeted intervention[J]. Signal Transduct Target Ther, 2021, 6(1):263. doi: 10.1038/s41392-021-00658-5.
[8]	Bahall V, De Barry L, Rampersad A. Clear cell carcinoma arising from abdominal wall endometriosis-a report on two cases and literature review[J]. World J Surg Oncol, 2022, 20(1):86. doi: 10.1186/s12957-022-02553-x. pmid: 35292079
[9]	彭佩轩, 王莉. 铁死亡在子宫内膜异位症中的研究进展[J]. 国际妇产科学杂志, 2022, 49(5):481-485. doi: 10.12280/gjfckx.20220451.
[10]	Liu GY, Sabatini DM. mTOR at the nexus of nutrition, growth, ageing and disease[J]. Nat Rev Mol Cell Biol, 2020, 21(4):183-203. doi: 10.1038/s41580-019-0199-y.
[11]	Liu D, Wei H, Huang J, et al. Clear Cell Adenocarcinoma Arising from Endometriosis in Abdominal Wall Cesarean Section Scar: A Case Report and Literature Review[J]. Int J Womens Health, 2023, 15:25-32. doi: 10.2147/IJWH.S382235. pmid: 36636515
[12]	Horton JD, Dezee KJ, Ahnfeldt EP, et al. Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases[J]. Am J Surg, 2008, 196(2):207-212. doi: 10.1016/j.amjsurg.2007.07.035. pmid: 18513698
[13]	Petit C, Donval L, Chandeze MM, et al. Surgery of abdominal wall endometriosis associated with clear-cell carcinoma: Case report and review[J]. J Gynecol Obstet Hum Reprod, 2023, 52(4):102561. doi: 10.1016/j.jogoh.2023.102561.
[14]	Liu G, Wang Y, Chen Y, et al. Malignant transformation of abdominal wall endometriosis: A systematic review of the epidemiology, diagnosis, treatment, and outcomes[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 264:363-367. doi: 10.1016/j.ejogrb.2021.08.006. pmid: 34391052
[15]	Jaramillo-Cardoso A, Balcacer P, Garces-Descovich A, et al. Multimodality imaging and clinicopathologic assessment of abdominal wall endometriosis: knocking down the enigma[J]. Abdom Radiol(NY), 2020, 45(6):1800-1812. doi: 10.1007/s00261-018-1666-1.
[16]	Robinson KA, Menias CO, Chen L, et al. Understanding malignant transformation of endometriosis: imaging features with pathologic correlation[J]. Abdom Radiol(NY), 2020, 45(6):1762-1775. doi: 10.1007/s00261-019-01914-7.
[17]	Bats AS, Zafrani Y, Pautier P, et al. Malignant transformation of abdominal wall endometriosis to clear cell carcinoma: case report and review of the literature[J]. Fertil Steril, 2008, 90(4):1197.e13-e16. doi: 10.1016/j.fertnstert.2007.08.080.
[18]	WHO classification of tumours editorial board. WHO classification of tumours:female genital tumours[M]. 5th ed. Lyon: International Agency for Research on Cancer, 2020:65-67.
[19]	Sampson JA. Endometrial carcinoma of the ovary, arising in endometrial tissue in that organ[J]. Arch Surg, 1925, 10(1):1-72. doi: 10.1001/archsurg.1925.01120100007001.
[20]	Scott RB. Malignant changes in endometriosis[J]. Obstet Gynecol, 1953, 2(3):283-289. pmid: 13087921
[21]	Lai YL, Hsu HC, Kuo KT, et al. 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[J]. Int J Environ Res Public Health, 2019, 16(4):552. doi: 10.3390/ijerph16040552.
[22]	Mazzola Poli de Figueiredo S, Belyansky I, Lu R. Pitfalls and complications of enhanced-view totally extraperitoneal approach to abdominal wall reconstruction[J]. Surg Endosc, 2023, 37(5):3354-3363. doi: 10.1007/s00464-022-09843-1.
[23]	中华医学会外科学分会疝与腹壁外科学组. 腹腔内补片修补术中国专家共识(2022版)[J]. 中国实用外科杂志, 2022, 42(7):721-729. doi: 10.19538/j.cjps.issn1005-2208.2022.07.01.
[24]	Bourdel N, Durand M, Gimbergues P, et al. Exclusive nodal recurrence after treatment of degenerated parietal endometriosis[J]. Fertil Steril, 2010, 93(6):2074.e1-e6. doi: 10.1016/j.fertnstert.2009.11.004.
[25]	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[J]. World J Surg Oncol, 2016, 14(1):300. doi: 10.1186/s12957-016-1054-7. pmid: 27912770
[26]	Feng Z, Wen H, Ju X, et al. Treatment for clear cell carcinoma of the abdominal wall at a tertiary cancer center[J]. Sci Rep, 2022, 12(1):10820. doi: 10.1038/s41598-022-14917-0. pmid: 35752641
[27]	Giannella L, Serri M, Maccaroni E, et al. Endometriosis-associated Clear Cell Carcinoma of the Abdominal Wall After Caesarean Section: A Case Report and Review of the Literature[J]. In Vivo, 2020, 34(4):2147-2152. doi: 10.21873/invivo.12021.
[28]	孙国栋, 姜旖, 袁琳, 等. 巨大腹壁子宫内膜异位症恶变一例并文献复习[J]. 国际妇产科学杂志, 2022, 49(3):321-324. doi: 10.12280/gjfckx.20210944.
[29]	Taburiaux L, Pluchino N, Petignat P, et al. Endometriosis-Associated Abdominal Wall Cancer: A Poor Prognosis?[J]. Int J Gynecol Cancer, 2015, 25(9):1633-1638. doi: 10.1097/IGC.0000000000000556. pmid: 26448542
[30]	Foley CE, Ayers PG, Lee TT. Abdominal Wall Endometriosis[J]. Obstet Gynecol Clin North Am, 2022, 49(2):369-380. doi: 10.1016/j.ogc.2022.02.013.
[31]	Karapolat B, Kucuk H. A Rare Cause of Abdominal Pain: Scar Endometriosis[J]. Emerg Med Int, 2019, 2019:2584652. doi: 10.1155/2019/2584652.
[32]	卫蔷, 刘兴会. 剖宫产术中的无瘤防御问题——腹壁子宫内膜异位症的预防[J]. 中国实用妇科与产科杂志, 2023, 39(1):31-34. doi: 10.19538/j.fk2023010110.
[33]	Alnafisah F, Dawa SK, Alalfy S. Skin Endometriosis at the Caesarean Section Scar: A Case Report and Review of the Literature[J]. Cureus, 2018, 10(1):e2063. doi: 10.7759/cureus.2063.