Ten cases of malignant tumors arising in foci of gonadal and extragonadal endometriosis are reported and added to 195 previously reported cases from the English literature. The ovary was the primary site in 165 (78.7%) of the cases, whereas extragonadal sites represented 44 (21.3%). Endometrioid adenocarcinomas accounted for 69% of the lesions, clear-cell carcinomas 13.5%, sarcomas 11.6%, and rare cell types 6%. Extragonadal lesions were mostly endometrioid tumors (66%) and sarcomas (25%). Tumors arising in endometriosis were predominantly low grade and confined to the site of origin. Radiation therapy was often able to control completely tumors limited to the pelvis, but was not beneficial in metastatic disease. Only one patient had a response to chemotherapy. Fourteen patients received postoperative progestin therapy, with a 77% 5-year survival. Follow-up has been reported in 86 patients. The tumor was either confined to the ovary (57), confined to the extragonadal site of origin (11), or spread throughout the peritoneal cavity (18). With each of these situations, the 5-year survival was 65, 100, and 10%, respectively. Fourteen patients had malignant transformation in endometriosis associated with presumed estrogenic stimulation; most lesions (69%) were well differentiated and the 5-year survival was 82%. After surgical resection, we recommend that progestin therapy be included in the treatment of cancer arising in endometriosis. The actual frequency of malignancy arising in endometriosis may be higher than reported.
To analyse the relationship between endometriosis and epithelial ovarian cancer. We analyzed retrospectively the 20 cases associated with endometriosis in 371 cases of epithelial ovarian cancer, and these 20 cases were also compared with the left 351 cases not associated with endometriosis(including endomtriod carcinoma 38 cases and clear cell carcinoma 39 cases). Among 20 cases, endomtriod carcinoma and clear cell carcinoma were most frequently associated with endometriosis, with 11 cases and 7 cases respectively, there was also 1 case of gland carcinoma and 1 case of serous papillary carcinoma. Cases of carcinomas associated with endometriosis had higher pathological grade and 5-year survival probability (Kaplan-Meier method) than those cases not associated with endometriosis. There is a close relationship between endometriosis and ovarian endomtriod carcinoma and clear cell carcinoma, the malignant transformation of endometriosis foci may be an important origin of them. Drug therapy is recommended for endomtriosis after the operation. In the treatment of endomtriod carcinoma and clear cell carcinoma, progestin can be used as an accessory method.
To investigate the occurrence of ovarian cancer (OC) arising in ovarian endometriosis (OE) diagnosed in our laboratory, and the relation of the disease to patient age. Histopathological reports were reviewed in cases of endometriosis and ovarian cancer diagnosed between 1982 and 1989 and in 1997. The occurrence of OE and OC was studied in relation to patient age. Of the 796 OE cases, 36 (4.5%) ovarian cancers were found in the eight-year period, and of the 216 OC cases 36 (16.7%) were associated with OE; 12 patients (1.7%) were under 50 years old and 24 (22.9%) were over 50. In 1997 there were 168 cases of OE, and 4 cases were associated with OC. Of the 60 OC cases 4 cases arose in endometriosis. Two patients were over 50 and two under 50. In our report the occurrence of OC arising in OE was most influenced by patient age, the extent of sampling and the consistency of histologic reports about the presence of endometriosis in ovarian adenocarcinoma.
EndometriosisMalignant TransformationOvarian Cancer in PregnancyOvarian Clear Cell Carcinoma
Sugiyama T et al., 1997·Eur J Obstet Gynecol Reprod Biol
We encountered a case of ovarian cancer in a 33-year-old, 8-week pregnant woman. Histological examination revealed both a transitive form of ovarian endometriosis with marked decidual changes due to pregnancy and clear cell carcinoma. Benign and borderline clear cell adenofibroma and benign and borderline endometrioid adenofibroma were also found. Parts of these adenofibromas showed transformation to clear cell carcinoma. This case suggests that clear cell carcinoma can arise from clear cell adenofibromas and/or ovarian endometriosis, even in young patients.
EndometriosisMalignant TransformationAtypical EndometriosisEndometriosis-Associated Ovarian Cancer
The incidence of ovarian atypical endometriosis and its association with malignant epithelial tumours in a consecutive series of cases during the period 1987 to 1995 were studied. Atypical glandular changes were observed in four (1.7%) of 255 ovarian endometriosis cases and one patient with ovarian atypical endometriosis developed subsequent endometrioid carcinoma in the abdominal wall. Fifty-four (24.1%) of the 224 ovarian cancers were associated with ovarian endometriosis; 21 with typical and 33 with atypical endometriosis. Clear cell carcinomas and endometrioid carcinomas were most frequently associated with endometriosis, with 54% (27 of 50 cases) and 41.9% (13 of 31), respectively. Atypical endometriosis was found in 18 clear cell carcinomas, in seven endometrioid carcinomas, in four serous carcinomas, in three mucinous borderline tumours, and in one serous borderline tumour. In 13 cases, the atypical endometriosis was in contiguity with malignant epithelial tumours. We consider that atypical endometriosis possesses a precancerous potential or is most frequently associated with clear cell and endometrioid carcinomas. Close screening of cellular atypia or hyperplasia in ovarian endometriosis and careful long-term follow-up of patients with atypical endometriosis is required.