Endometrial cancer with concomitant endometriosis is highly associated with ovarian endometrioid carcinoma: a retrospective cohort study

Abstract

Background Endometriosis is assumed to be involved in ovarian cancer development, which is called endometriosis-associated ovarian cancer (EAOC). Uterine endometrial cells may be the cell of origin of EAOC. Accumulated carcinogenic changes in the uterine endometrial cells may increase the risk of developing EAOC. To further understand the pathogenesis of EAOCs, we focused on the clinicopathological characteristics of EAOCs in endometrial cancer patients with concomitant endometriosis. Methods We retrospectively reviewed 376 patients who were surgically treated for stage I–III endometrial cancer. Clinicopathological characteristics were compared between patients with and without endometriosis. Furthermore, the incidence of simultaneous endometrial and ovarian cancer (SEOC) and the histological characteristics of SEOC were compared between the two groups. Results Among 376 patients with endometrial cancer, 51 had concomitant endometriosis. Patients with endometriosis were significantly younger and more frequently had endometrioid G1/G2 tumors than those without endometriosis. The incidence of SEOCs was significantly higher in endometrial cancer patients with endometriosis than those without it (p < 0.0001); notably, 12 of 51 endometrial cancer patients with endometriosis (24%) had SEOCs. All of the ovarian cancers in endometrial cancer patients with endometriosis were endometrioid carcinomas. Moreover, even in those without endometriosis, endometrioid carcinoma was the most common histological type of SEOC. Conclusion We revealed that endometrial cancer patients with endometriosis had a high probability of SEOC and that endometrioid carcinoma was the most common histological subtype of SEOC regardless of the presence of endometriosis. For patients with endometrial cancer and endometriosis, careful examination of ovarian endometriotic lesions may be important to detect EAOCs.

Endometriosis and endometrial cancer: A propensity score-adjusted real-world data study

“… 16 Additionally, genomic studies have demonstrated that cancer-related genomic alterations are present in some endometriotic lesions, supporting the hypothesis that endometriosis is the origin of ovarian endometrioid and clear cell carcinoma. 12 , 15 , 24 …”

Endometriosis-Related Ovarian Cancers: Evidence for a Dichotomy in the Histogenesis of the Two Associated Histotypes

“…It is known that the association between endometrial neoplasm and ovarian endometrioid cancer occurs in 3.1–10.0% of patients with endometrial cancer and in 10% of those with ovarian cancer [ 28 ]. In fact, in a recent retrospective cohort study by Ishizaka and colleagues has demonstrated that endometrial cancer associated with endometriosis has a high probability of being simultaneous at ovarian carcinoma, in particular, endometrioid histotype is the most common histological subtype present [ 29 ]. Moreover, different types of gene-based biomarkers such as ARID1A , PIK3CA , KRAS and CTNNB1 are recurrently mutated in endometrial cancer type I, endometriosis and endometriosis-associated ovarian tumors [ 30 ].…”

“…In line with this observation, the solid/cystic rate in the ECC group at macroscopic histology was significantly lower than the EAEOC group. Arguments against the theory by Kajihara et al include (i) the demonstration by various authors of the endometrioid histology in synchronous ovarian and endometrial carcinomas associated with endometriosis which is not consistent with the endometrioid tumor development from the Müllerian epithelium [ 29 , 30 ]; (ii) evidence supporting different origins for the various forms of endometriosis [ 8 ] does not tend to indicate two different histogeneses for the endometriotic cyst, as the theory of Kajihara and coworkers would imply. Endometriosis in different sites might indeed have a different histogenesis.…”