Clear-cell carcinoma originating from cesarean section scar: two case reports

Area of Science:

• Gynecologic Oncology
• Surgical Pathology
• Oncologic Surgery

Background:

• Clear-cell carcinoma arising from surgical cesarean section scars is an exceptionally rare entity.
• This study presents two cases of clear-cell carcinoma originating from abdominal wall scars, diagnosed 20 and 23 years post-cesarean section.

Observation:

• Two female patients presented with large lower abdominal masses at prior cesarean section scar sites.
• Histological analysis confirmed malignancy, leading to full-thickness abdominal wall resection.
• One patient required additional pelvic surgery (total abdominal hysterectomy, bilateral salpingo-oophorectomy) due to pelvic mass involvement.

Findings:

• Despite similar initial adjuvant chemotherapy (paclitaxel and carboplatin), prognoses varied significantly.
• Recurrence occurred in one patient five months post-chemotherapy, while the other remained disease-free.
• Differences in tumor spread, margin status, and surgical extent influenced outcomes.

Implications:

• Complete surgical excision of abdominal wall masses with wide, tumor-free margins is crucial.
• Exploration of the abdominopelvic space, including total abdominal hysterectomy and bilateral salpingo-oophorectomy, may be warranted during initial surgery.
• Early and aggressive surgical management can potentially improve prognosis for this rare malignancy.