Although endometriosis mainly affects pelvic organs, particularly ovaries, it can show extrapelvic localisation. Endometriosis can also develop in abdominal wall surgical scars and episiotomy scars. Malign transformation of the endometriotic tissue has been known for a long time. Due to the scarcity of malignant conditions originating from endometriosis in surgical scars, relevant data are insufficient. As its pathophysiological mechanism is poorly understood, there is a lack of experience in its management. In current case, we represent a 43-year-old woman with a small mass in her vulva that is diagnosed as “high grade serous carcinoma related with endometriosis in episiotomy scar” after 16 years of her last delivery with episiotomy. We were able to identify only one case report with similar characteristics in the literature. After diagnosing the histologic nature of the mass in right labia majora, we performed a posterior hemivulvectomy and unilateral inguinofemoral lymphadenectomy. Plastic surgeons used a groin myocutenous flap for the reconstruction of the tissue defect in operation field. She has discharged in 4th postoperative day without a serious problem. Histopathological evaluation, confirming the above diagnosis, showed a 1 mm sized residual tumor tissue with an invasion depth more than 1 mm and with at least 2 cm clear margins in surgical specimen. Three of the extracted 7 lymph nodes were identified as metastatic. As an adjuvant therapy, we recommended platin-based chemotherapy and radiotherapy for relevant vulvar and inguinal regions.
Anahtar Kelimeler: endometriosis, serous papillary cystadenocarcinoma, episiotomy scar
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