НА СТЫКЕ ДИСЦИПЛИНObjective of the Paper: To describe a clinical case of atypical endometriosis (AEM) of the urinary bladder. Key Points: The paper describes a first-hand observation of a clinical case of AEM of the urinary bladder in a woman of reproductive age. The authors propose a panel of immunohistochemical markers that will improve the diagnosis of AEM, viewed as a morphological precancerous condition. They also discuss the latest data from the literature on the specific aspects of the pathogenesis, diagnosis, clinical course, treatment methods, and risk factors for malignant transformation of this rare condition. Conclusion: Challenges in the differential diagnosis and histological verification of AEM of the urinary bladder make it necessary to evaluate the immunohistochemical expression of the BAF250a (ARID1a), β-catenin, PTEN, Ki-67, and p53 markers. Curative resection of areas of endometriosis combined with long-term adjuvant treatment with dienogest is the most effective therapeutic approach. Keywords: atypical endometriosis, endometriosis of the urinary bladder, dienogest, urinary bladder resection, conserving therapy, BAF250a (ARID1a), PTEN, β-catenin. «АВА-ПЕТЕР». 199034, г. Санкт-Петербург, Университетская наб., д. 7-9. E-mail: protasova1966@yandex.ru (Окончание на с. 62.) Атипический эндометриоз мочевого пузыряЦель статьи: представить клиническое наблюдение атипического эндометриоза мочевого пузыря (ЭМП). Основные положения. В статье описано собственное наблюдение атипической формы ЭМП у женщины репродуктивного возраста. Предложена панель иммуногистохимических маркеров, которая позволит улучшить диагностический поиск атипического эндометриоза, рассматриваемого как морфологическая форма предрака. Освещены также особенности патогенеза, диагностики, клинического течения, методов лечения и риска злокачественной трансформации этого редкого заболевания, рассматриваемые в современной литературе. Заключение. Сложность дифференциальной диагностики и гистологической верификации атипической формы ЭМП диктует необходи-мость проведения иммуногистохимического исследования с оценкой экспрессии маркеров BAF250a (ARID1a), β-катенина, PTEN, индекса Ki-67, p53. Радикальное удаление эндометриоидных очагов в комбинации с длительной адъювантной терапией диеногестом является наиболее эффективным методом лечения. Ключевые слова: атипический эндометриоз, эндометриоз мочевого пузыря, диеногест, резекция мочевого пузыря, органосохраняющее лечение, BAF250a (ARID1a), PTEN, β-катенин.
Hypothesis/aims of study. The current analysis was undertaken to assess the incidence of malignant diseases in patients with endometriosis. Study design, materials and methods. This is a cohort study of women with surgically verified endometriosis retrieved from the Saint Petersburg 122 Clinical Hospital Discharge Register 1996–2006 (n = 1551). Data were linked to the Saint Petersburg Cancer Agency to identify cases of malignancy. Results. Malignant diseases were identified in 6.3% (n = 98) of cases. The median follow-up was 12.2 (7.5) years. Breast cancer (n = 29), ovarian cancer (n = 7), endometrial cancer (n = 7), thyroid cancer (n = 7), colorectal cancer (n = 6), melanoma (n = 6), non-Hodgkin’s lymphoma (n = 4), and glioblastoma (n = 3) were prevalent. Conclusion. The incidence of cancer in patients with endometriosis is low. Women with endometriosis have an increased risk of some malignancies, particularly ovarian cancer.
Background. In 2016, the World Health Organization published an updated version of the Histological Classification for ovarian tumors presenting a new category of endometriosis-associated tumors. The predictors of malignant transformation of endometriosis have not been clearly defined so far.Purpose. The search for histological and immunohistochemical markers of endometriosis-associated malignancy.Materials and methods. 28 female patients with endometrioid ovarian cancer and 11 patients with clear cell ovarian carcinoma were enrolled. Histological and immunohistochemical studies were carried out using conventional techniques. Immunohistochemistry was applied to determine the hormone receptor status: expression of steroid hormone receptors, BAF250a (ARID1A), PTEN, P-catenin, MSH6, PMS2, р-53, WT-1, proliferative index (Ki-67). Microsatellite instability (MSI) testing was conducted according to the standard protocol.Results. In all cases of ovarian cancer, histological examination showed one of the endometriosis features. Atypical endometriosis was found in 39 % (11 / 28) of endometrioid tumors and in 9% (1/ 11) of clear cell carcinomas. Endometrioid ovarian cancer was found to be ER (74±7,8%) — and PR (67±5,4%) — positive; Ki-67 index was 68,2±3,7 %; loss of BAF250a (ARID1A) expression was observed in 14% (4/ 28), loss of PTEN expression in 29 % (8 / 28), nuclear expression of P-catenin in 32% (9/28) of cases. Loss of MMR expression was detected in 7% (2/28) of cases. MSI was found in one case only, which was also associated with loss of expression of BAF250a (ARID1A) and MSH6. Clear cell carcinoma of the ovary showed histological criteria for endometriosis; however, there were no changes immunohistochemical markers expression that were typical for endometriosis-associated malignancies. It could be due to a small number of patients in the group so further research is needed.Conclusion. Atypical endometriosis may be a morphological precursor of endometrioid and clear cell carcinoma of the ovary. Comprehensive assessment of a marker panel consisting of BAF250a (ARID1A), P-catenin, PTEN, p53, Ki-67 index, PMS2 and MSH6 will allow improving the diagnosis of atypical endometriosis and endometriosis-associated ovarian cancer.
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