Abstract：
Endometriosis, affecting 6%-10% of women of reproductive age, can lead to severe symptoms such as chronic pelvic pain and infertility. Among its rarer manifestations is abdominal wall endometriosis (AWE), which has been increasingly reported following cesarean deliveries. This case discusses a 39-year-old woman who presented with a 13-year history of cyclical pain at her cesarean section scar, exacerbated over the last year by the development of a painful abdominal mass. Medical evaluations indicated endometriosis at the scar, with further investigations including ultrasound and magnetic resonance imaging showing involvement of the rectus abdominis muscle. Elevated tumor markers HE4 and CA-125, along with a biopsy, confirmed adenocarcinoma. The patient underwent extensive surgical treatment, including the resection of the mass, hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Pathology confirmed moderately differentiated infiltrative adenocarcinoma originating from endometriosis. Despite the absence of postoperative chemotherapy, the patient showed no recurrence, emphasizing the effectiveness of comprehensive surgical management. This case highlights the critical importance of recognizing the potential for malignant transformation in AWE, particularly following cesarean deliveries, and underscores the necessity for vigilant monitoring and personalized treatment strategies. The management of AWE, especially when malignant transformation is suspected, necessitates a multidisciplinary approach similar to that used in ovarian cancer, focusing on rigorous surgical intervention and the potential for adjuvant therapies.
摘要：
子宫内膜异位症,影响6%-10%的育龄妇女，会导致严重的症状，如慢性盆腔疼痛和不孕。其罕见的表现是腹壁子宫内膜异位症（AWE），剖宫产后越来越多的报道。该病例讨论了一名39岁的妇女，她的剖宫产疤痕有13年的周期性疼痛史，在过去的一年中，由于腹部疼痛的发展而加剧。医学评估显示子宫内膜异位症在疤痕处，进一步的调查包括超声和磁共振成像显示腹直肌受累。升高的肿瘤标志物HE4和CA-125，以及活检，确诊腺癌。病人接受了广泛的手术治疗,包括切除肿块,子宫切除术,双侧输卵管卵巢切除术，和淋巴结清扫术。病理证实中分化浸润性腺癌起源于子宫内膜异位症。尽管没有术后化疗，病人没有复发,强调全面手术管理的有效性。这个案例强调了认识到AWE中恶性转化的可能性的关键重要性，特别是在剖腹产之后，并强调了警惕监测和个性化治疗策略的必要性。AWE的管理，特别是当怀疑恶性转化时，需要类似于卵巢癌的多学科方法，专注于严格的手术干预和辅助治疗的潜力。
