Endometrial cancer and abdominal wound recurrence

A 65-year-old woman had a total abdominal hysterectomy and bilateral salpingo-oophorectomy through a Pfannenstiel incision for a Stage Ib, Grade 2 endometrial adenocarcinoma with extension to the middle third of the myometrium. No adjuvant treatment was given. She presented 7 years later with a large suprapubic mass and the entire lower central abdominal wall was removed and closed with Marlex mesh. Pathology revealed a moderately well-differentiated adenocarcinoma, very similar to the previous cancer with follow-up at 15 months revealing no evidence of recurrence. This case represents growth of implanted tumor cells in the incision that occurred 7 years previously at the time of an uneventful hysterectomy without tumor transgression. It is felt that there was intraoperative tumor cell extrusion through the cervical os with subsequent growth of viable tumor cells.