LAUSR

Study Objective Ovarian cancer arising from benign endometriotic has been widely reported. cystic adenomyoma is a rare form of adenomyosis. And clear cell carcinoma arising from cystic adenomyosis is even more unusual. Here we report a case of clear cell carcinoma arising from cystic adenomyosis treated with laparoscopic surgery. Design Case report. Setting A tertiary care hospital. Patients or Participants 41-years-old Japanese woman, gravida 4 paras 2. Two years ago, she was pointed out an index finger size cystic lesions in the uterine posterior wall. Interventions Laparoscopic surgery. Measurements and Main Results At her follow-up visit, she did not complain of any particular symptoms, but enlargement of the cystic lesion was pointed out by the transvaginal ultrasound. MRI was performed, and MRI findings revealed that the cystic lesion was cystic adenomyosis with a mural nodule in the cyst. Moreover, the nodule showed slight enhancement with contrast images and high-intensity on diffusion-weighted images in MRI. These findings were suspected malignancy. We performed laparoscopic hysterectomy. Postoperative pathological findings are adenomyosis with clear cell carcinoma within the mural nodule was diagnosed as clear cell carcinoma. We performed laparoscopic bilateral oophorectomy and pelvic lymph node dissection under the laparoscopic surgery as additional surgery. No residual tumor and metastasis was observed, and cytology of ascites was negative. Her final diagnosis was endometrial cancer stage IB, pT1BN0M0, since the nodule was in the outer half of the uterine myometrium. After the second surgery, she suffered from chylous ascites for three months. Adjuvant chemotherapy with paclitaxel and carboplatin was performed after ascites was disappeared. Conclusion Although carcinoma arising from cystic adenomyosis is rare, the enlargement or the appearance of nodules might be suspicious findings of carcinoma arising from cystic adenomyosis. And laparoscopic surgery was useful for diagnosis and treatment of this rare condition.