Clear cell carcinoma arising in previous episiotomy scar: a case report and review of the literature

Abstract

Background: Malignant transformation of endometriosis associated with episiotomy scar is a rare event, especially histological type of clear cell adenocarcinoma. There are only three clear cell carcinoma in episiotomy scar reported, no standard treatment established.

Case presentation: A 36-year-old woman presented with a two-month history of painless but puritic perineal lump which she noticed was gradually enlarging. She had undergone surgical excision of a mass in the episiotomy scar 9 year ago and resequently histological type of endometriosis. Physical examination revealed a 10 × 5 cm soft, purple scar which is closely related to the apex of the episiotomy.We underwent a local excision of the mass for a biopsy . The second surgery performed after one cycle of paclitaxel and cisplatin (TP) to permit clearance of tumor while preserving normal vaginal function.Pathological result was clear cell adenocarcinoma. Two cycles of TP adjuvant chemotherapy were administrated after surgery.

Conclusions: We report a case of primary clear cell carcinoma developing within a previous episiotomy scar in a patient with a history of endometriosis, along with a review of the literature. Accumulation of management data on these rare tumors and Long-term follow-up of such patients is therefore important.

Fig. 1

a Perioperative photograph showing a 10 × 5 cm perineal mass arising from the episiotomy scar. b Cut surface of the tumor, pink-yellow in color

Fig 2

Microscopic images: c clear cell adenocarcinoma: marked cellular pleomorphism, clear cytoplasm, nuclei show pleomorphism. d Characteristic hobnail cells are noted in our case. e Endometriosis: cystic dilated endometrial glands in dense stroma. f Transitional zone revealing clear cell carcinoma arising from the endometriotic focus