Abstract
Introduction
Studies of clear cell adenocarcinoma of the ovary (CCAO) arising from endometriosis are scant.
Materials and methods
The author reviewed 13 cases CCAO of our pathology laboratory for the presence of endometriosis within the tumor. Eight (61.5%) of the 13 tumors contained endometriosis within the tumor. Of the eight cases, seven were atypical endometriosis and one was ordinary endometriosis. The age of the eight patients with CCAO ranged from 35 to 82 years with a median of 52 years.
Results
Grossly, the ovarian tumors of CCAO were characterized by unilocular cystic lesions containing solitary or multiple nodules in the inner surfaces. The outer surface was smooth and free of tumor. Histologically, the nodules showed typical features of pure CCAO with clear cells, hobnail cells, and hyalinized stroma. The non-nodular flat areas of the tumor were composed of a layer of atypical clear cells and endometriosis consisting of a layer of endometrial epithelium and endometrial stroma. Incipient foci of CCAO were occasionally recognized in the atypical clear cells. Seven cases with endometriosis showed atypia of the endometrial epithelium (atypical endometroiosis), and one case showed no atypia. There was contiguity between the CCAO and atypical clear cells and between atypical clear cells and endometriosis. Contiguity between atypical endometriosis and CCAO was also recognized in a few areas. The outer surface was devoid of tumor cells and endometriosis.
Conclusions
The author speculates as follows. An endometrial cyst develops in the ovary. Its epithelium undergoes initiation, thus giving rise to atypical endometriosis consisting of dysplastic or intraepithelial neoplastic epithelium. The atypical endometriosis further undergoes initiation, leading to the atypical clear cells, and ultimately leads to CCAO showing a unilocular cyst consisting of inner masses of CCAO and flat areas composed of a layer of atypical clear cells with incipient CCAO and atypical endometriosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Scully RE, Richardson GS, Barlow JF (1966) The development of malignancy in endometriosis. Clin Obstet Gynecol 9:384–411
Nishida M, Watanabe K, Sato N, Ichikawa Y (2000) Malignant transformation of ovarian endometroosis. Gynecol Obstet Invest 50(Suppl 1):18–25
Yoshikawa H, Jimbo H, Okada S, Matsumoto K, Onda T, Yasugi T, Taketani Y (2000) Prevalence of endometriosis in ovarian cancer. Gynecol Obstet Invest 50(supple 1):11–17
Montag AG, Jenison EL, Griffiths CT, Welch WR, Lavin PT, Knapp RC (1989) Ovarian clear cell carcinoma: a clinicopathologic analysis of 44 cases. Int J Gynecol Pathol 8:85–96
Matalliotakis I, Muhutte NG, Koukoura O, Arici A (2006) Endometriosis associated with stage IA clear cell ovarian carcinoma in a woman with IVF-ET treatment in the Yale Series. Arch Gynecol Obstet 274274:184–186
Goumenou A, Matalliotakis I, Mahutte N, Koumantakis E (2006) Endometriosis mimicking advanced ovarian cancer. Fertil Sterill 86:219.e23–219.e25
Fukunaga M, Nomura K, Ishikawa E, Ushigome S (1997) Ovarian atypical endometriosis: its close association with malignant epithelial tumours. Histopathology 30:249–255
Stern RC, Dash R, Bentley RC, Snyder MJ, Haney AF, Robboy SJ (2001) Malignancy in endometriosis: frequency and comparison of ovarian and extraovarian types. Int J Gynecol Pathol 20:133–139
Moll UM, Chumas JC, Chalas E, Mann WJ (1990) Ovarian carcinoma arising in atypical endometriosis. Obstet Gynecol 75:537–539
Yamamoto S, Tsuda H, Suzuki K, Takano M, Tamai S, Matsubara O (2009) An allelotype analysis indicating the presence of two different ovarian clear-cell carcinogenic pathways: endometriosis-associated pathways vs clear cell adenofibroma pathways. Virchows Arch 455:261–270
Obata K, Hoshian H (2000) Common genetic change between endometriosis and ovarian cancer. Gynecol Obstet Invest 50(suppl 1):39–43
Kato N, Sasou S, Motoyama T (2006) Expression of hepatocyte nuclear factor-1beta (HNF-1beta) in clear cell tumors and endometriosis of the ovary. Mod Pathol 19:83–89
Finas D, Huszar M, Agic A, Dogan S, Kiefel H, Riedle S, Gast D, Marcovich R, Noack F, Altevogt P, Fogel M, Hornung D (2008) L1 cell adhesion molecule (L1CAM) as a pathogenetic factor in endometriosis. Hum Reprod 23:1053–1062
Kobayashi H, Kajikawa H, Kanayama S, Yamada Y, Furukawa N, Nogichi T, Haruta S, Yoshida S, Sakata M, Sado M, Oi H (2009) Molecular pathogenesis of endometriosis-associated clear cell carcinoma of the ovary. Oncol Rep 22:233–240
Dent J, Hall GD, Wilkinson N, Perron TJ, Richmond I, Markham AF, Murphy H, Bell SM (2003) Cytogenetic alterations in ovarian clear cell carcinoma detected by comparative genomic hybridization. Br J Cancer 88:1578–1583
Ho CM, Lin MC, Huang SH, Huang CJ, Lai HC, Chien TY, Chang SF (2009) PTEN promoter methylation and LOH of 10q22–23 in PTEN expression of ovarian clear cell adenocarcinomas. Gynecol Oncol 112:307–313
Yamaguchi K, Mandai M, Oura T, Matsumura N, Hamanishi J, Baba T, Matsui S, Murphy SK, Konishi I (2010) Identification of an ovarian clear cell carcinoma gene signature that reflects inhererent disease biology and the carcinogenic processes. Oncogene 29:1741–1752
Conflict of interest
The author has no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Terada, T. Clear cell adenocarcinoma of the ovary arising in atypical endometriosis: a report of eight cases. Arch Gynecol Obstet 285, 229–233 (2012). https://doi.org/10.1007/s00404-011-1929-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-011-1929-3