Identification of multiple pathways involved in the malignant transformation of endometriosis (Review)

Abstract

Abstract. The association between endometriosis and malignant transformation has often been described in the medical literature. A search was conducted between 1966 and 2010 through the English language literature (online Medline PubMed database) using the keywords endometriosis combined with malignant transformation. The search revealed an increase in reports describing endometriosis and malignancy. Approximately 1.0% of women with endometriosis have lesions that undergo malignant transformation. The malignant processes that are associated with endometriosis may be classified into three groups: i) epithelial ovarian cancers (endometrioid adenocarcinoma and clear cell carcinoma), ii) other Müllerian-type tumors, including Müllerian-type mucinous borderline tumor and serous borderline tumor and iii) sarcomas such as adenosarcoma and endometrial stromal sarcoma in the female pelvic cavity. Persistent oxidative stress induced by endometriosis-dependent hemorrhage may be associated with carcinogenesis. In conclusion, the malignant transformation of endometriosis has multiple pathways of development and may share a common pathogenic mechanism; iron-induced oxidative stress derived from repeated hemorrhage.

Cyst fluid hemoglobin species in endometriosis and its malignant transformation: The role of metallobiology

“…Individuals with endometriosis require a long follow-up, with particular attention paid not only to dysmenorrhea and infertility but also to potential malignant transformation (3). In Japan, <1% of women with endometriosis develop ovarian cancer (3)(4)(5)(6). Substantial histological evidence indicates that endometriosis is associated with ovarian cancer, particularly endometrioid carcinoma and clear cell carcinoma (5).…”

“…Although the pathogenesis of carcinogenesis remains unclear, it is assumed that malignant transformation may be derived from pathways associated with hyperestrogenism, chronic inflammation and oxidative stress (7). Inflammation and particularly oxidative stress, which is secondary to the influx of erythrocytes and subsequent hemolysis that occurs during retrograde menstruation and inner hemorrhage in endometriotic lesions, may be one of the causative factors in carcinogenesis (4). Hemoglobin (Hb), heme and iron may have a significant impact on oxidative stress in the development of endometriosis and malignant transformation (8).…”

Endometriosis-associated ovarian cancer

“…Он не имеет специфических клинических симптомов, что приводит к поздней диагностике, неблагоприят-ному прогнозу и высокой летальности. Прогностиче-скими факторами риска развития такого рака явля-ются признаки длительной гиперэстрогении: раннее менархе, продолжительность болезни более 10 лет, молодой возраст, прогестероновая недостаточность, пременопаузальный и постменопаузальный статус пациенток, размер эндометриоидных кист яични-ков более 6-8 см, бесплодие, хронический стресс, ожирение [12]. Также к факторам высокого риска ма-лигнизации можно отнести низкую чувствительность эндометриоидных гетеротопий к гормонотерапии, так называемый атипический эндометриоз [13].…”

The Association Between Endometriosis and Surface Epithelial Ovarian Tumors: A Review of Pathological Data

“…The estimated prevalence of endometriosis is 2% to 10% in the premenopausal, 2% to 4% in post-menopausal women, and 25% to 80% of infertile ones (1)(2)(3)(4)(5)(6)(7). The most common site of occurrence in endometriosis is ovary, but different locations in pelvic area are frequently involved.…”