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Clinicopathological characteristics of ovarian carcinomas associated with endometriosis

  • Gynecologic Oncology
  • Published:
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Abstract

Introduction

Substantial histopathology data provide evidence that endometriosis might be viewed as a precursor lesion of endometrioid and clear cell carcinoma of the ovary, via intermediary atypical borderline lesions. Also, genes involved in both endometriosis and epithelial ovarian cancer have been shown to play a role in the pathogenesis of endometriosis-associated ovarian carcinoma.

Material and methods

A retrospective study of 17 cases of ovarian carcinomas associated with endometriosis, diagnosed between 2000 and 2009, at Aretaieion Hospital of University of Athens, is presented. 10/17 cases in this study (58.8%) were clear cell carcinomas (CCC), 6/17 cases (35.3%) were endometrioid adenocarcinomas (EAC) and 1/17 cases (5.9%) was a serous carcinoma associated with ovarian endometriosis. Patients’s age was 27–76 years (mean age 58 years). Typical ovarian endometriosis was documented in 8/17 (47%) of the tumors. In 9/17 cases, areas of fibrosis or cystic lesions infiltrated by iron-laden macrophages and endometrial-like stroma, consistent with endometriosis, were observed.

Conclusion

In comparison with common epithelial ovarian cancers, CCC and EACs of the ovary were presented at earlier stages. Cytoreductive surgical treatment is critical in order to plan appropriate post-operative management.

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References

  1. Kaku T, Ogawa S, Kawano Y, Ohishi Y, Kobayashi H, Hirakawa T, Nakano H (2003) Histological classification of ovarian cancer. Med Electron Microsc 36:9–17

    Article  PubMed  Google Scholar 

  2. Kobayashi H, Kajiwara H, Kanayama S, Yamada Y, Furukawa N, Noguchi T, Haruta S, Yoshida S, Sakata M, Sado T, Oi H (2009) Molecular pathogenesis of endometriosis- associated clear cell carcinoma of the ovary (Review). Oncol Rep 22:233–240

    Article  PubMed  CAS  Google Scholar 

  3. Crozier MA, Copeland LJ, Silva EG, Gerhenson DM, Stringer CA (1989) Clear cell carcinoma of the ovary: a study of 59 cases. Gynecol Oncol 35:199–203

    Article  PubMed  CAS  Google Scholar 

  4. Varma R, Rollason T, Gupta JK, Maher ER (2004) Endometriosis and the metastatic process. Reproduction 127:293–304

    Google Scholar 

  5. Erzen M, Kovacic J (1998) Relationship between endometriosis and ovarian cancer. Eur J Gynaecol Oncol 19:553

    PubMed  CAS  Google Scholar 

  6. Kurman RJ, Ellenson LH, Ronnett BM (eds) (2011) Blaustein’s pathology of the female genital tract, 6th edn. Springer, New York, pp 647–649

  7. Kobayashi H (2009) Ovarian cancer in endometriosis: epidemiology, natural history and clinical diagnosis. Int J Clin Oncol 14:378–382

    Article  PubMed  Google Scholar 

  8. Kobayashi H, Sumimoto K, Kitanaka T et al (2008) Ovarian endometrioma—risk factors of ovarian cancer development. Eur J Obstet Gynecol Reprod Biol 138:187–193

    Article  PubMed  Google Scholar 

  9. Jimbo H, Yoshikawa H, Onda T et al (1997) Prevalence of ovarian endometriosis in epithelial ovarian cancer. Int J Gynecol Obstet 59:245–250

    Article  CAS  Google Scholar 

  10. Sugiyama T, Kamura T, Kigawa J, Terakawa N et al (2000) Clinical characteristics of clear cell carcinoma of the ovary: a distinct histologic type with poor prognosis and resistance to platinum-based chemotherapy. Cancer 88:2584–2589

    Article  PubMed  CAS  Google Scholar 

  11. Schiller W (1929) Mesonephroma ovarii. Int J Cancer 35:1

    Google Scholar 

  12. Saphir O, Lackner JE (1944) Adenocarcinoma with clear cells (hypernephroid) of ovary. Surg Gynecol Obstet 79:539

    Google Scholar 

  13. Teilum G (1946) Gonocytoma: homologous ovarian and testicular tumors. Acta Pathol Microbiol Scand 23:242

    Article  Google Scholar 

  14. Scully RE (1970) Recent progress in ovarian cancer. Hum Pathol 1:73

    Article  PubMed  CAS  Google Scholar 

  15. Scully RE, Barlos JF (1967) Mesonephroma of the ovary: tumor of mullerian nature related to endometrioid carcinoma. Cancer 20:1405

    Article  PubMed  CAS  Google Scholar 

  16. Shevchuk MM, Winckler-Monsanto B, Fenoglio CM et al (1981) Clear cell carcinoma of the ovary: a clinicopathologic study with review of the literature. Cancer 47:1344

    Article  PubMed  CAS  Google Scholar 

  17. Prowse AH, Manek S, Varma R et al (2006) Molecular genetic evidence that endometriosis is a precursor of ovarian cancer. Int J Cancer 119:556–562

    Article  PubMed  CAS  Google Scholar 

  18. Defrere S, Lousse JC, Gonzalez-Ramos R, Colette S, Donnez J, van Langendonckt A (2008) Potential involvement of iron in the pathogenesis of peritoneal endometriosis. Mol Hum Reprod 14:377–385

    Article  PubMed  CAS  Google Scholar 

  19. Yamaguchi K, Mandai M, Toyokuni S, Hamanishi J, Higuchi T, Takakura K, Fujii S (2008) Contents of endometriotic cysts, especially the high concentration of free iron, are a possible cause of carcinogenesis in the cysts through the ironinduced persistent oxidative stress. Clin Cancer Res 14:32–40

    Article  PubMed  CAS  Google Scholar 

  20. Zorn KK, Bonome T, Gangi L, Chandramouli GVR, Awtrey CS et al (2005) Gene expression profiles of serous, endometrioid and clear cell subtypes of ovarian and endometrial cancer. Clin Cancer Res 11(18):6422–6430

    Google Scholar 

  21. Yoshida S, Furukawa N, Haruta S, Tanase Y, Kanayama S, Noguchi T et al (2009) Theoretical model of treatment strategies for clear cell carcinoma of the ovary: focus on perspectives. Cancer Treat Rev 35:608–615

    Article  PubMed  CAS  Google Scholar 

  22. Kurman RJ, Visvanathan K, Roden R, Shih I-M (2008) Early detection and treatment of ovarian cancer: shifting from early stage to minimal volume of disease based on a new model of carcinogenesis. Am J Obst Gynecol 4:351–356

    Article  Google Scholar 

  23. Christie M, Oehler MK (2006) Molecular pathology of epithelial ovarian cancer. J Br Menopause Soc 12(2):57–63

    Article  PubMed  Google Scholar 

  24. Kajihara H, Yamada Y, Kanayama S, Furukawa N, Noguchi T, Haruta S, Yoshida S, Sado T, Oi H, Kobayashi H (2010) Clear cell carcinoma of the ovary: potential pathogenic mechanisms (Review). Oncol Rep 23(5):1193–1203

    PubMed  CAS  Google Scholar 

  25. Kato N, Sasou S, Motoyama T (2006) Expression of hepatocyte nuclear factor 1beta (HNF-1b) in clear cell tumors and endometriosis of the ovary. Mod Pathol 19:83–89

    Article  PubMed  CAS  Google Scholar 

  26. Skirnisdottir I, Seidal T, Karlsson MG, Sorbe B (2005) Clinical and biological characteristics of clear cell carcinomas of the ovary in FIGO stages I–II. Int J Oncol 26(1):177–183

    PubMed  Google Scholar 

  27. Sato N, Tsunoda H, Nishida M, Morishita Y, Takimoto Y, Kubo T, Noguchi M (2000) Loss of heterozygosity on 10q23.3 and mutation of the tumor suppressor gene PTEN in benign endometrial cyst of the ovary: possible sequence progression from benign endometrial cyst to endometrioid carcinoma and clear cell carcinoma of the ovary. Cancer Res 60:7052–7056

    PubMed  CAS  Google Scholar 

  28. Kurman RJ, Shih I-M (2008) Pathogenesis of ovarian cancer. Lessons from morphology and molecular biology and their clinical implications. Int J Gynecol Pathol 27(2):151–160

    PubMed  Google Scholar 

  29. Keita M, Bessette P, Pelmus M, Ainmelk Y, Aris A (2010) Expression of interleukin-1 (IL-1) ligands system in the most common endometriosis-associated ovarian cancer subtypes. J Ovarian Res 3:3

    Article  PubMed  Google Scholar 

  30. Castiblanco GA, Pires NY, Wistuba OI, Riquelme SE, Andrade ML, Corvalan RA (2006) Pathogenetic role of PTEN tumor suppressor gene in ovarian cancer associated to endometriosis. Rev Med Chil 134(3):271–278

    Google Scholar 

  31. Jenison EL, Montag AG, Griffiths CT, Welch WR, Lavin PT, Greer J, Knapp RC (1989) Clear cell adenocarcinoma of the ovary: a clinical analysis, comparison with serous carcinoma. Gynecol Oncol 32(1):65–71

    Article  PubMed  CAS  Google Scholar 

  32. Takano M, Kikuchi Y, Yaegashi N, Kuzuya K, Ueki M, Tsuda H, Suzuki M et al (2006) Clear cell carcinoma of the ovary: a retrospective multicenter experience of 254 patients with complete surgical staging. Br J Cancer 94:1369–1374

    Article  PubMed  CAS  Google Scholar 

  33. Ryu SY, Park SI, Nam BH, Kim I, Yoo CW, Nam JH, Lee KH et al (2009) Prognostic significance of histological grade in clear cell carcinoma of the ovary: a retrospective study of Korean gynecologic oncology group. Ann Oncol 20:1032–1036

    Article  PubMed  Google Scholar 

  34. Behbakht K, Randall TC, Benjamin I, Morgan MA, King S, Rubin SC (1998) Clinical characteristics of clear cell carcinoma of the ovary. Gynecol Oncol 70:255–258

    Article  PubMed  CAS  Google Scholar 

  35. Takano M, Sasaki N, Kita T, Kudoh K, Fujii K et al (2008) Survival analysis of ovarian clear cell carcinoma confined to the ovary with or without comprehensive surgical staging. Oncol Rep 19:1259–1264

    PubMed  CAS  Google Scholar 

  36. Shi M, Zhang Y, Shen K, Lang J, Huang H, Wu M (2002) Clinical characteristics of clear cell carcinoma of the ovary. Zhonghua Fu Chan Ke Za Zhi 37(3):161–163

    PubMed  Google Scholar 

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Correspondence to C. Iavazzo.

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Kondi-Pafiti, A., Papakonstantinou, E., Iavazzo, C. et al. Clinicopathological characteristics of ovarian carcinomas associated with endometriosis. Arch Gynecol Obstet 285, 479–483 (2012). https://doi.org/10.1007/s00404-011-1957-z

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  • DOI: https://doi.org/10.1007/s00404-011-1957-z

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