Malignant neoplasms arising in endometriosis

Heaps, JM; Rk, Nieberg; Berek, J. S.

doi:10.1016/0020-7292(91)90262-4

Cited by 253 publications

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“…Ipsilateral ovarian endometriosis has been detected in 11-31%, ovarian endometriosis of unspecified laterality in 9-20%, and pelvic endometriosis in 11-28% of cases of ovarian endometrioid carcinoma. 96,[99][100][101][102][103][104][105][106][107] Well-differentiated or low-grade endometrioid ovarian carcinomas are associated with an especially high frequency of associated endometriosis (63%) or endometrioid adenofibromas (47%). 108 Russell 104 reported a 47% frequency of pelvic endometriosis in 30 cases of clear cell carcinoma of the ovary, and Aure et al 99 demonstrated a 24% frequency of ovarian endometriosis in 59 cases of the same type of tumor; both of those figures were surprisingly higher than the figures given by the same authors for the association of endometriosis with endometrioid carcinoma (28 and 9%, respectively).…”

Section: Morphologic Datamentioning

confidence: 99%

Origins and molecular pathology of ovarian cancer

2005

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Epithelial ovarian cancer comprises the majority of malignant ovarian tumors in adult women. These neoplasms are classified into distinct morphologic categories based on the appearance of the epithelium into tumors of serous, mucinous, endometrioid, clear cell, transitional, squamous, mixed and undifferentiated type. Current data indicate that each of these histologic subtypes is associated with distinct morphologic and molecular genetic alterations: high-grade serous and possibly endometrioid carcinomas most probably arise from surface epithelial inclusion glands with TP53 mutations and dysfunction of BRCA1 and/or BRCA2; low-grade serous carcinomas probably arise in a stepwise fashion in an adenoma-borderline tumor-carcinoma sequence from typical to micropapillary borderline tumors to low-grade invasive serous carcinoma via activation of the RAS-RAF signaling pathway secondary to mutations in KRAS and BRAF; mucinous carcinomas arise via an adenoma-borderline tumor-carcinoma sequence with mutations in KRAS; low-grade endometrioid carcinomas arise from endometriosis via mutations in CTNNB1 (the gene encoding b-catenin) and PTEN. Although the morphologic data strongly support an origin of clear cell carcinoma from endometriosis, there is limited data on the genetic alterations in these uncommon tumors. Thus it is likely that most low-grade, relatively indolent ovarian carcinomas of serous, mucinous and endometrioid type arise from pre-existing cystadenomas or endometriosis whereas most high-grade serous carcinomas arise without an easily identifiable precursor lesion. Modern Pathology (2005) 18, S19-S32. doi:10.1038/modpathol.3800306Keywords: ovarian cancer; ovarian borderline tumors; histogenesis; molecular pathology Epithelial ovarian cancer comprises the majority of malignant ovarian tumors in adult women. These neoplasms are classified into distinct morphologic categories based on the appearance of the epithelium into tumors of serous, mucinous, endometrioid, clear cell, transitional, squamous, mixed and undifferentiated type. 1,2 Two types of ovarian surface epithelial lesions have been described as possible precursors of these carcinomas: lesions that appear in situ in surface epithelium or surface epithelial inclusion glands (SEIG); and preexisting benign epithelial ovarian tumors and endometriosis. The morphologic and genetic data implicating each as a precursor lesion of the major histologic subtypes of ovarian carcinoma are discussed. Surface epithelium and surface epithelial inclusion glands as precursor lesions Morphologic DataTwo types of morphologic data are available regarding the malignant potential of ovarian surface epithelium and inclusion glands, alterations in these structures and studies on microscopic ovarian carcinoma.Surface epithelium and surface epithelial inclusion glands Despite the widespread acceptance of the origin of surface epithelial cancers from the ovarian surface epithelium and its inclusion glands, only rarely have putative precursor lesions been described at these sites. Two...

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Section: Morphologic Datamentioning

confidence: 99%

Origins and molecular pathology of ovarian cancer

2005

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“…To our knowledge, ovarian endometriosisincreasingin size and accom panied by marked decidual bleeding during pregnancyis a rareoccurrence. The malignant transformation of endometri osis has been well documented, and persistent estrogenic stimulation has been implicated as a cause [4,5]. Becauseof this,ovarianendometri osis in pregnant women should be treated with special attention to structural changes that occur during pregnancy.…”

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Decidualized ovarian endometriosis mimicking malignancy.

Miyakoshi¹,

Tanaka²,

Gabionza³

et al. 1998

American Journal of Roentgenology

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Becausesonography is nowcapable of achieving increased resolution, ovarian tumors are more fre quently found in early pregnancy. In this case, we describea patientin the secondtrimester with ovarian endometriosis, which enlarged and was accompanied by structural changes inside the tumor. Case ReportA 28-year-old primigravidawas first seen in our antenatal clinic at 5 weeks of gestation. She had a history ofovarian endometriosis and had been treated with a gonadotropin-releasing hormone analogue before the pregnancy. A sonographic examination showed an intrauter me gestationsac and a right ovariantumor.The tumor was a unilocular cyst with fine in ternal echoesand a maximum diameter of 45 mm (Fig. 1A). Because the patient had a his tory of endometriosis, the tumorwasbelieved to represent an endometrial cyst and was treated conservatively.At 16 weeks ofgestation, sonographic exam ination revealeda fetus appropriatefor the ges tational age and showed an increase in size of the ovariancyst, which had reacheda maximum diameter of 85 mm. On transvaginalsonogra phy, irregularhyperechogenicrepresentingpap illary excrescences structures were seen inside the cyst. Color-flow Doppler sonography de picted vascularity within the solid irregular ar eas (Fig. 1B). These sonographic changes became more remarkable at i8 weeks of gesta flon. For further evaluation of a possible malig nancy, MR imaging was performed.The high signalintensityon TI-andT2-weightedimages was in the cystic portion of the tumor, suggest ing blood products. The solid portion was dark on Tl-weighted images and bright on 12-weighted images, suggesting malignancy that may have arisenfrom the endometriosis (Figs. lCand lD).On exploratory laparotomy performed at 20 weeksof gestation,a right ovariantumor adher ingtotheposterior wall ofthe uteruswasfound. A smallamountof asciteswasalsonoted.The tumor, which contained chocolatelike bloody fluid,hadalreadyraptured. After suctioning the fluid from the tumor, a right salpingo-oophorec tomy was performed.Papillaryexcrescences werefoundprotruding intothelumenof thetu mor. Final histopathologicexamination re vealed ovarian endometnosis with marked decidual changes and hemorrhage and without evidenceof malignancy (Fig. 1E). The patient recovered promptly and delivered a 3704-g healthymale infant at 40 weeksof gestation. during human pregnancy;thus, we did not use this contrast material in our patient. The clinical findings were indicative of malig nancy;however,final histopathologic exami nation of the tumor merely revealed solid tissue representing massive decidualization and hemorrhage. To our knowledge, ovarian endometriosisincreasingin size and accom panied by marked decidual bleeding during pregnancyis a rareoccurrence. The malignant transformation of endometri osis has been well documented, and persistent estrogenic stimulation has been implicated as a cause [4,5]. Becauseof this,ovarianendometri osis in pregnant women should be treated with special attention to structural changes that occur during pregnancy. Disc...

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“…Una serie importante de casos de endometriosis del tracto intestinal demuestra la alta frecuencia de compromiso transmural, pero reconoce que debido al amplio espectro de distorsión de la pared intestinal, principalmente en el compromiso mucoso, puede simular una gran variedad de enfermedades infecciosas, isquémicas, inflamatorias y neoplásicas (2). La perforación intestinal en pacientes con endometriosis intestinal es rara y se ha informado malignidad en 0,7 % a 1 % de las pacientes, la mayoría de las veces en el ovario (16).…”

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