Author of

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  P1.14 - Thymoma/Other Thoracic Malignancies (Not CME Accredited Session) (ID 946)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall

  • 26647

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    P1.14-10 - Surgical Treatment of a Rare Case of Clear Cell Carcinomatous Transformation of a Diaphragmatic Endometriosis Focus (ID 14303)

    16:45 - 18:00  |  Author(s): Gabriella Serio
    • Abstract
    • Slides

    Background
    

    Thoracic endometriosis is an ectopic, unusual localization of endometrial tissue in endothoracic organs. The development of thoracic endometriosis can be determined by the embolization of endometriotic foci to the lung by lymphatic, hematic or trans-diaphragmatic way. We report a rare case of carcinomatous transformation of a diaphragmatic endometriosis focus, successfully treated with surgery.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    A 46-year old woman, with a history of previous operation for bilateral endometriotic pelvic cyst, presented to our institution with dyspnoea and massive right pleural effusion, which was treated with chest drainage. After drainage, chest and abdomen computerized tomography (CT) and magnetic resonance imaging (MRI) showed a large (7 x 6 cm), roundish, inhomogeneous, capsulated mass of the right hemidiaphragm, causing compression of the adjacent lung and liver. Fiberbronchoscopy showed an extrinsic compression of subsegmental bronchi of the basal pyramid of the right lung. After cardio-respiratory function evaluation, the patient underwent videothoracoscopic pleural biopsies with frozen section negative for malignancy, therefore we converted in antero-lateral thoracotomy and a radical surgical resection of the diaphragmatic mass, en-bloc with the adherent and apparently infiltrated lung and hepatic parenchyma, was performed.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Postoperative course was uneventful. Histopathology revealed a clear cell carcinoma deriving from a malignant transformation of an ectopic diaphragmatic endometriosis focus; Ki67 was > 50%; PI3KCA and BRAF genes were not mutated. Total body 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT showed bilateral increased ovarian uptake, thus the patient underwent radical abdominal hysterectomy, with diagnosis of endometriosis, and subsequent adjuvant chemotherapy for the diaphragmatic clear cell carcinoma. Total body CT scan at 7 months from surgery shows neither local recurrence, nor distant metastases.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Thoracic endometriosis requires a multidiciplinary approach and management. In our experience, surgery represented the treatment of choice, in order to ensure oncological radicality, in a young patient with a rare condition of carcinomatous transformation of a diaphragmatic endometriosis focus, which should be considered among the possible evolutions of endometriosis. To the best of our knowledge, this is the first reported case of radical surgical treatment of a clear cell carcinomatous transformation of a diaphragmatic endometriosis focus.

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