Malignant transformation of residual endometriosis after hysterectomy: a case series

Karanjgaokar, V.; Murphy, Denis J.; Samra, Jagbir S.; Mann, Christopher H.

doi:10.1016/j.fertnstert.2009.08.012

Cited by 12 publications

(18 citation statements)

References 15 publications

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“…About 13 patients had medical histories that noted endometriosis in more than one site ( Brooks and Wheeler, 1977 ; Duun et al , 1993 ; Abu et al , 1997 ; Powell et al , 2001 ; Jones et al , 2002 ; Petersen et al , 2002 ; Soliman and Evans, 2004 ; Milam et al , 2006 ; Noel et al , 2006 ; Efthymiou, 2009 ; Karanjgaokar et al , 2009 ), and 13 patients had histories of ovarian endometriosis ( Brooks and Wheeler, 1977 ; Duun et al , 1993 ; Abu et al , 1997 ; Jimenez et al , 2000 ; Powell et al , 2001 ; Montamedi, 2002 ; Petersen et al , 2002 ; Soliman and Evans, 2004 ; Milam et al , 2006 ; Efthymiou, 2009 ; Karanjgaokar et al , 2009 ). Some histories specified ‘severe endometriosis’ ( n = 4) ( Duun et al , 1993 ; Abu et al , 1997 ; Taylor et al , 1999 ; Efthymiou, 2009 ), while others reported ‘extensive endometriosis’ ( n = 4) ( Reimnitz et al , 1988 ; Soliman and Evans, 2004 ; Noel et al , 2006 ).…”

Section: Resultsmentioning

confidence: 99%

The management of menopause in women with a history of endometriosis: a systematic review

Gemmell

Webster

Kirtley

et al. 2017

Human Reproduction Update

101

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BACKGROUNDEndometriosis is typically regarded as a premenopausal disease, resolving after natural or iatrogenic menopause due to declining oestrogen levels. Nonetheless, case reports over the years have highlighted the incidence of recurrent postmenopausal endometriosis. It is now clear that both recurrence and malignant transformation of endometriotic foci can occur in the postmenopausal period. Postmenopausal women are commonly treated with hormone replacement therapy (HRT) to treat climacteric symptoms and prevent bone loss; however, HRT may reactivate endometriosis and stimulate malignant transformation in women with a history of endometriosis. Given the uncertain risks of initiating HRT, it is difficult to determine the best menopausal management for this group of women.OBJECTIVE AND RATIONALThe aim of this study was to systematically review the existing literature on management of menopausal symptoms in women with a history of endometriosis. We also aimed to evaluate the published literature on the risks associated with HRT in these women, and details regarding optimal formulations and timing (i.e. initiation and duration) of HRT.SEARCH METHODSFour electronic databases (MEDLINE via OVID, Embase via OVID, PsycINFO via OVID and CINAHL via EbscoHost) were searched from database inception until June 2016, using a combination of relevant controlled vocabulary terms and free-text terms related to ‘menopause’ and ‘endometriosis’. Inclusion criteria were: menopausal women with a history of endometriosis and menopausal treatment including HRT or other preparations. Case reports/series, observational studies and clinical trials were included. Narrative review articles, organizational guidelines and conference abstracts were excluded, as were studies that did not report on any form of menopausal management. Articles were assessed for risk of bias and quality using GRADE criteria.OUTCOMESWe present a synthesis of the existing case reports of endometriosis recurrence or malignant transformation in women undergoing treatment for menopausal symptoms. We highlight common presenting symptoms, potential risk factors and outcomes amongst the studies. Sparse high-quality evidence was identified, with few observational studies and only two randomized controlled trials. Given this paucity of data, no definitive conclusions can be drawn concerning risk.WIDER IMPLICATIONSDue to the lack of high-quality studies, it remains unclear how to advise women with a history of endometriosis regarding the management of menopausal symptoms. The absolute risk of disease recurrence and malignant transformation cannot be quantified, and the impact of HRT use on these outcomes is not known. Multicentre randomized trials or large observational studies are urgently needed to inform clinicians and patients alike.

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Section: Resultsmentioning

confidence: 99%

The management of menopause in women with a history of endometriosis: a systematic review

Gemmell

Webster

Kirtley

et al. 2017

Human Reproduction Update

101

View full text Add to dashboard Cite

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“…Several investigators have reported malignant transformation of extragonadal endometriosis following unopposed estrogen replacement . In this case, the patient had also been prescribed unopposed estrogen therapy (1.25 mg/day) for 8 years.…”

Section: Discussionmentioning

confidence: 92%

“…The major regimen of chemotherapy for endometriosis‐related malignancy (endometrioid carcinoma) has been reported to be paclitaxel/carboplatin . Alternatively, carboplatin, ifosfamide and doxorubicin have been reported for high‐grade endometrial stromal sarcoma. The follow‐up periods of all patients in the systematic review were from 3 to 60 months.…”

Section: Discussionmentioning

confidence: 99%

“…a,b). Sampson's and Scott's criteria include: the coexistence of carcinoma and endometriosis in the same tissue; the presence of tissue resembling endometrial stroma surrounding characteristic epithelial glands; no other primary tumor sites being found and the morphologic demonstration of benign endometriosis contiguous with malignant tissue is a prerequisite for malignancy originating in endometriosis . In this case, all criteria were met.…”

Section: Case Reportmentioning

confidence: 94%

“…The major sites of extragonadal endometriosis are the rectovaginal septum, abdominal wall, pleura and vagina. It has been reported that malignant transformation of extragonadal endometriosis after hysterectomy is caused by unopposed estrogen therapy . In a systematic review of the management of menopause in women with a history of endometriosis including malignant transformation, the patients received unopposed estrogen replacement for a median duration of 6.7 years (range 3–20 years) .…”

Section: Introductionmentioning

confidence: 99%

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Long‐term survival of a patient with malignant transformation of extragonadal endometriosis treated solely with chemotherapy: A case report

Kondo

Maki

Nii

et al. 2018

J of Obstet and Gynaecol

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A 52-year-old woman presented to our hospital complaining of genital bleeding and was found to have a 50-mm vaginal tumor that involved the bladder, rectum, and small bowel and extended to the left pelvic side wall. Her history included a bilateral salpingo-oophorectomy and a total abdominal hysterectomy for fibroids and endometriosis. She had been prescribed estrogen replacement therapy (1.25 mg/day) following the second surgery and continued it for 8 years. The pathology of the vaginal biopsy showed endometrioid adenocarcinoma. Total pelvic exenteration was recommended for complete resection, but she chose chemotherapy (paclitaxel 175 mg/m and carboplatin AUC:6). Clinical complete remission was obtained for 11 years. She had a recurrence 11 years later. She was again found to have a 5-cm vaginal tumor. Surgical excision with upper vaginectomy was performed. The tumor was resected without invasion of the bladder, rectum and small bowel. Histologic examination of the specimen confirmed clear cell carcinoma with endometriosis. Chemotherapy may be the first-line treatment that can preclude aggressive surgery for malignant transformation of extragonadal endometriosis. However, combined chemotherapy and surgery is necessary for this disease.

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Relationship between endometriosis and cancer from current perspective

Kökçü

2011

Arch Gynecol Obstet

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Malignant transformation of residual endometriosis after hysterectomy: a case series

Cited by 12 publications

References 15 publications

The management of menopause in women with a history of endometriosis: a systematic review

The management of menopause in women with a history of endometriosis: a systematic review

Long‐term survival of a patient with malignant transformation of extragonadal endometriosis treated solely with chemotherapy: A case report

Relationship between endometriosis and cancer from current perspective

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