Endometriosis-derived clear-cell carcinoma masquerading as vaginal cancer

Crystal M. Yu, Malolan S. Rajagopalan, Thomas C. Krivak, Paniti Sukumvanich, Sushil Beriwal
In: Applied Radiation Oncology · 2013 · pp. 4–5 · doi:10.37549/aro1031 · W4380928046
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A 47-year-old woman with prior endometriosis achieved complete clinical response to chemoradiation and laparoscopic-assisted brachytherapy for an adnexal clear-cell carcinoma masquerading as vaginal cancer.

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This case report describes a 47-year-old woman with a history of endometriosis who presented with a vaginal mass initially misdiagnosed as primary vaginal cancer. Advanced imaging revealed the lesion was actually an endometriosis-associated clear-cell carcinoma originating in the adnexal region and extending to the vagina. The patient achieved a complete clinical response following treatment with concurrent chemoradiation, including laparoscopic-assisted high-dose rate brachytherapy. This paper is centrally about endometriosis — specifically documenting its malignant transformation into clear-cell carcinoma and presenting a novel radiation therapy approach for this complication.

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Discussion

Since its first description by Sampson, endometriosis has been considered a premalignant lesion with documented degeneration into clear-cell or papillary adenocarcinoma. 1 This is an unusual case of endometriosis-associated clear-cell carcinoma arising in the adnexal region and presenting as vaginal cancer. This case was uniquely treated with chemoradiation and interstitial brachytherapy with complete metabolic and clinical response. Endometriosis-associated ovarian carcinoma (EAOC) is a well-reported phenomenon. Even though it may present as a vaginal mass, 2,3,4 in our patients, positron emission tomography/computed tomography (PET/CT) and pelvic MRI confirmed that the disease originated in the adnexa with extension into the vagina. Ours is the first case report utilizing laparoscopic-assisted HDR brachytherapy. Due to the lateral location of disease in the paravaginal tissue and pelvic sidewall, laparoscopic assistance was necessary to dissect and manipulate the small bowel so that the interstitial needles could be safely placed. HDR brachytherapy was delivered using an image-guided technique that enabled the conformal delivery of radiation to the target while minimizing dose to the critical structures.

Conclusion

While the role of adjuvant chemotherapy in the treatment of endometriosis-associated clear-cell carcinoma arising in the adnexal region and presenting as vaginal cancer still remains to be defined, this patient has achieved a complete clinical response to therapy.

References

- Sampson J. Endometrial carcinoma of the ovary, arising in endometrial tissue in that organ. Arch Surg.. 1925;10:1-72. - Shah C. Clear cell adenocarcinoma of the vagina in a patient with vaginal endometriosis. Gynecology Oncology.. 2006;103:1130-1132. - Mabrouk M. Mixed adenocarcinoma of the rectovaginal septum associated with endometriosis and endometrial carcinoma: a case report. Case Rep Oncology.. 2011;4:149-154. - Guiou M. Primary Clear cell adenocarcinoma of the rectovaginal septum treated with concurrent chemoradiation therapy: a case report. Int J Gynecol Cancer.. 2008;18(5):1118-1121. Citation Endometriosis-derived clear-cell carcinoma masquerading as vaginal cancer. Applied Radiation Oncology. 2013;2(4):4-5. doi:10.37549/ARO1031. .

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endometriosis

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