**9. Complications**

The typical complications of scar endometriosis are relatively high recurrence rate, malignancy and anatomical defects. Olejek et al. (43) reported a very high recurrence rate – 8

Endometrial Tumors in Postoperative Scars - Pathogenesis, Diagnostics and Treatment 97

[4] Attia L., Ben Temime R., Sidhom J., Sahli A., Makhlouf T., Chachia A., Koubaa A. &

[5] Aydin Ö.: *Scar endometriosis – a gynecologic pathology often presented to the general surgeon* 

[6] Barisić G., Krivokapić Z. & Jovanović D.: *Perineal endometriosis in episiotomy scar with anal* 

[7] Benoit L., Arnould L., Cheynel N., Diane B., Causeret A., Machado A., Collin F., Fraisse J.

[8] Buda A., Ferrari L., Marra C., Passoni P., Perego P. & Milani R.: *Vulvar endometriosis in* 

[9] Bulun S.E., Imir G., Utsunomyia H., Thung S., Gurates B., Tamura M. & Lin Z.: *Aromatase in endometriosis and uterine leiomyomata.* J Steroid Biochem Mol Biol 2005, 95, 57-62. [10] das Chagas Medeiros F., Magno Cavalcante D.I., da Silva Medeiros M.A. & Eleutério J.:

[11] Chatterjee S.K.: *Scar endometriosis: a clinicopathologic study of 17 cases.* Obstet Gynecol

[12] Chene G., Darcha C., Dechelotte P., Mage G. & Canis M.: *Malignant degeneration of* 

[13] Chiang D.T. & The W.T.: *Cutaneous endometriosis – surgical presentations of a gyanecological* 

[14] Chung H.W., Lee J.Y., Moon H.S., Hur S.E., Park M.H., Wen Y. & Polan M.L.: *Matrix* 

[15] Clausen I. & Nielsen KT.: *Endometriosis in the groin.* Int J Gynaecol Obst 1987, 25, 469-71. [16] Ding D.C. & Hsu S.: *Scar endometriosis at the site of cesarean section.* Taiwan J Obstet

[17] Dougherty L.S. & Hull T.: *Perineal endometriosis with anal sphincter involvement*. Dis Colon

[18] Douglas C. & Rotimi O.: *Extragenital endometriosis – a clinicopathological review of a Glasgow hospital experience with case illustrations.* J Obstet Gynaecol 2004, 24, 804-8. [19] Ducarme G., Uzan M. & Poncelet C. : *Endometriosis mimicking hernia recurrence.* Hernia

[20] Fedele L., Bianchi S., Frontino G., Zanconato G. & Rubino T.: *Radical excision of inguinal* 

[21] Francica G., Scarano F., Scotti L., Angelone G. & Giardiello C.: *Endometriomas in the* 

*vary with the size of the lesion.* J Clin Ultrasound 2009, 37, 215-20.

*region of a scar from cesarean section: sonographic appearance and clinical presentation* 

Med 2010, 88, 841-3.

2006, 17, 646-9.

2008, 277, 255-6.

1980, 56, 81-4.

787-95.

Gynecol 2006, 45 247-9.

Rectum 2000, 43, 1157-60.

2007, 11, 175-7.

*review.* Diagn Cytopathol 2011, 39, 18-21.

*condition..* Aust Fam Physician 2006, 35, 887-8.

*endometriosis.* Obstet Gynecol 2007, 110, 530-3.

Gynecol Cancer 2007, 17, 709-14.

105-9.

32, 6-11.

Zermani R.: *A case of cutaneous endometriosis developed on an abdominal scar.* Tunis

*rather than the gynaecologist: report of two cases.* Langenbecks Arch Surg 2007, 392,

*sphincter involvement: report of two cases and review of the literature.* Int Urogynecol J

& Cuisenier J.: *Malignant extraovarian endometriosis: a review.* Eur J Surg Oncol 2006,

*surgical scar after excision of the Bartholin gland: report of a case.* Arch Gynecol Obstet

*Fine-needle aspiration cytology of scar endometriosis: study of seven cases and literature* 

*perineal endometriosis in episiotomy scar, case report and review of the literature.* Int J

*metalloproteinase-2, membranous type 1 matrix metalloproteinase, and tissue inhibitor of metalloproteinase-2 expression in ectopic and eutopic endometrium. .*Fertil Steril 2002, 78,

from 33 (over 24%) operated patients during on an average 19 months. It might be caused by larger size of endometriomas and no medical therapy after their excision. Leite et al. (38) described only two cases (6,0%).

Sampson (49) was the first to document the possibility of malignant changes in ectopic endometrial tissue. Chene et al. (12) consider that 0,3 – 1% of scar endometriosis undergo malignant degeneration reporting a case of serous papillary cystadenocarcinoma. In our clinical material (43) also in one patient after two surgical removals of the cesarean scar endometriosis preformed in other centers (where endometrioma was diagnosed) papillary adenocarcinoma was recognized. Matsuo et al. (39) described primary clear cell carcinoma developed in previous abdominal scar post endometriosis surgery. Authors mentioned that endometrioid adenocarcinoma, clear cell adenocarcinoma and adenosarcoma are also common enough in extragenital localization. Razzouk et al. (46) reported a case of mixed clear cell and endometrioid carcinoma arising in a recurrent cesarean section scar endometrioma.
