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Immunologic factors involved in the malignant transformation of endometriosis to endometriosis-associated ovarian carcinoma

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Abstract

Introduction

Endometriosis is a risk factor for low-grade serous, clear cell, and endometroid ovarian carcinoma. In both endometriosis and ovarian carcinoma, immunological factors are associated with clinical outcome. Chronic inflammation in endometriosis may be linked to tumorigenesis, but exact processes contributing to endometriosis-associated ovarian carcinoma remain unknown. This review aims to describe potential immunological factors involved in the malignant transformation of endometriosis into ovarian carcinoma.

Methods

PubMed and Embase were searched from inception up to October 2020 for studies comparing immunological processes in endometriosis and endometriosis-associated ovarian carcinoma.

Results

Detailed analysis of immune components in the malignant transformation of endometriosis into endometriosis-associated ovarian carcinoma is lacking. Altered levels of chemokines and cytokines as IL-6, IL-8, IL-10, and TNF-α are reported and the function, number and polarization of NK cells, dendritic cells, and monocytes differ between endometriosis and associated ovarian carcinoma compared to healthy tissue. In addition, altered inflammasome and complement systems, indicate a role for the immune system in the carcinogenesis of endometriosis.

Conclusion

Chronic inflammation in endometriosis may potentially drive inflammation-induced carcinogenesis in endometriosis-associated ovarian carcinoma. Exact immunological pathways and cellular processes remain unknown and require more thorough investigation.

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Data availability

All articles used are published full text articles.

Abbreviations

AE:

Atypical endometriosis

CCC:

Clear cell carcinoma

EAOC:

Endometriosis-associated ovarian carcinoma.

EC:

Endometrioid carcinoma

EOC:

Epithelial ovarian carcinoma

LGSC:

Low-grade serous carcinoma

OvCa:

Ovarian carcinoma

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Funding

This study did not receive any funding.

Author information

Authors and Affiliations

  1. Department of Gynecology, Catharina Hospital, Eindhoven, The Netherlands

    S. Leenen, M. Hermens, R. L. M. Bekkers & E. M. G. van Esch

  2. Department of Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands

    M. Hermens

  3. Department of Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands

    P. J. de Vos van Steenwijk

  4. GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands

    R. L. M. Bekkers

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  1. S. Leenen
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Contributions

RB and EE were responsible for the study initiative and study design. SL and MH conducted the literature search and performed the selection of manuscripts. All authors contributed to the writing of the manuscript.

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Correspondence to E. M. G. van Esch.

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All authors declare that they had no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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To our knowledge, this is the first review carried out that focusses solely on immunological factors involved in malignant transformation from endometriosis to associated ovarian carcinoma.

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Search specifics and exclusion protocol.

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Leenen, S., Hermens, M., de Vos van Steenwijk, P.J. et al. Immunologic factors involved in the malignant transformation of endometriosis to endometriosis-associated ovarian carcinoma. Cancer Immunol Immunother 70, 1821–1829 (2021). https://doi.org/10.1007/s00262-020-02831-1

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