Endometriosis with adenocarcinoma

A 44 years old patient noticed a subcutaneous tumor in the mons pubis.  Previous gynecological history was negative and no malignancies in family.  Since she was very busy no diagnostic procedures were performed.  After 6 months she underwent a MRI and an endometriosis was suspected.  After additional 3 months she had a biopsy of the 3-4 cm tumor.  Histology revealed endometriosis with adenocarcinoma.  She was referred to our department and we performed a wide local excision with partial resection of the underlying bone (since the tumor was fixed to the bone and an infiltration could not be excluded by MRI). Inguino-femoral lymph nodes and pelvic nodes were removed since in both areas enlarged lymph nodes have been described.  A laparoscopy and D&C has also been performed.  No further endometriosis could be visualized.  The final histology confirms endometriosis with highly differentiated adenocarcinoma (diameter is not clear due to prior biopsy but estimated to be 2-3 cm), some areas (11 mm) showed serous-papillary differentiation.  No vascular invasion has been observed.  All margins and lymph nodes were negative.  Endometrium was normal.  A PET-scan was negative.

What are your recommendations?  Thank you very much.

Christian Marth

Response # 1:
She should receive concurrent weekly cis-platin and 54 Gy RT in 1.8 Gy fx to the local post operative field, using perhaps direct electrons.
Any epithelial tumor with any degree of fixity requires post-op RT for its local control. Clear margin in a fixed tumor does not always guarantee local control. We prefer a lower dose of 54 Gy which in combination with cis-platin is very effective without causing visible or symptomatic late radiation effects. Since there is no evidence of any disease spread elsewhere, I do not think she would benefit from any systemic therapy.

Kailash Narayan

Response # 2:
Has she had  a hysterectomy &BSO as well ? If no disease outside the pelvis I would give her adjuvant chemo (carbo / taxol) and then full dose pelvic RT to include the mons.

Mary McCormack

Response # 3:
We would give chemorads then 4 cycles Carbo/Taxol/  Were receptors done for ER/PR?

Michael Quinn