Adenomyosis As a Confounder to Accurate Endometrial Cancer Staging

Khalifa, Mahmoud A.; Atri, Mostafa; Klein, Molly; Ghatak, Sayak; Murugan, Paari

doi:10.1053/j.sult.2019.04.004

Cited by 19 publications

(11 citation statements)

References 42 publications

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“…Furthermore, adenomyosis reduces the accuracy of magnetic resonance imaging in assessing the depth of invasion because it reduces the contrast between the muscular layers involved in endometrial cancer and adenomyosis. 30 Previously, Ali et al reassessed DMI in 100 specimens of endometrial cancer, and almost all endometrial cancers that were initially diagnosed as invasive were considered noninvasive in the review. 31 Thus, the higher the number of sections considered from a given specimen, the higher the frequency of diagnosis, 32 which might be attributed to inconsistent diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of co‐existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: A meta‐analysis

Duan

Zhang

2020

J of Obstet and Gynaecol

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Objective Published data on the impact of co‐existent adenomyosis on the prognosis of patients with endometrial cancer remains elusive, with studies reporting conflicting results. We conducted this meta‐analysis to evaluate the prognostic significance of co‐existent adenomyosis on clinical outcomes and tumor characteristics of endometrial cancer patients. Methods A comprehensive literature review of multiple databases was conducted; quality assessment of eligible studies was performed by the Newcastle‐Ottawa scale (NOS). The outcomes of interest were compared in endometrial cancer patients with or without adenomyosis. Hazards ratios (HR) and Odds ratios (OR) with 95% confidence interval (CI) were calculated as a measure of effects. Results Fourteen retrospective observational studies comprising 1308 endometrial cancer patients with adenomyosis and 3734 patients without adenomyosis were included in this meta‐analysis. Results indicated that endometrial cancer patients with adenomyosis was significantly associated with an increased overall survival rate (HR = 0.51; 95% CI = 0.38–0.69; P < 0.00001), but not with disease‐free survival rate (HR = 0.68; 95% CI = 0.30–1.53; P = 0.35); besides, significantly associated with decreased ratio of deep myometrial invasion (OR = 0.45; 95% CI = 0.33–0.60; P < 0.00001), lymphovascular space invasion (OR = 0.44; 95% CI = 0.29–0.68; P = 0.0002), an increased ratio of histological grade 1 (OR = 1.84; 95% CI = 1.34–2.53; P = 0.0002) and FIGO I‐II (OR = 1.85; 95% CI = 1.49–2.30; P < 0.00001). However, there was no significant difference in pathological type and lymph node metastasis. There was a low to high heterogeneity with I2 ranging from 0 to 67%. Conclusion This meta‐analysis indicated that co‐existent adenomyosis with endometrial cancer is associated with favorable tumor characteristics and could serve as a potential protective factor for the prognosis of endometrial cancer.

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Section: Discussionmentioning

confidence: 99%

Prognostic significance of co‐existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: A meta‐analysis

Duan

Zhang

2020

J of Obstet and Gynaecol

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“…As a result, diagnosis is often delayed. 8 This is thought to be another reason for the poor prognosis of EC-AIA. In the present case, although the endometrial cytology was positive or suspiciously positive, the biopsy tissue showed only metaplastic tissue, and it took 19 months from the initial diagnosis to the final definitive diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Endometrial Cancer Arising in Adenomyosis That Could Not Be Diagnosed by Endometrial Biopsy: A Case Report

et al. 2022

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Uterine adenomyosis is an estrogen-dependent tumor and one of the most common benign diseases in sexually mature women. The frequency of endometrial cancer associated with adenomyosis has been reported to be 18%-66%. On the other hand, endometrial cancer arising in adenomyosis (EC-AIA) is extremely rare. EC-AIA is now considered a different entity from and has a worse prognosis than endometrial cancer with adenomyosis (EC-A). In the present study, we report a case of endometrial cancer with adenomyosis in which endometrial biopsy failed to provide a definitive diagnosis. A 63-year-old female patient presented with endometrial thickening. Endometrial cytology was positive, and magnetic resonance imaging (MRI) showed small lesions suggestive of endometrial cancer with shallow invasion and adenomyosis. However, an endometrial biopsy showed only metaplasia, and careful follow-up was initiated. Subsequent endometrial cytology showed enlarged and round nuclei, uniform chromatin distribution, no thickening of nuclear margins, and abundant cytoplasm appearing in a sheet-like arrangement, suggesting atypical cells of endometrial glands with metaplasia. Three suspicious positive results and one positive result were observed, but repeated biopsies did not lead to the diagnosis of malignancy. The patient underwent diagnostic hysterectomy 19 months after the initial visit. The postoperative histopathological diagnosis was stage IA endometrial cancer (endometrioid carcinoma G1). This case of endometrial cancer associated with adenomyosis was difficult to diagnose. Our findings demonstrate that EC-AIA should be considered even if no lesions were detected by endometrial biopsy.

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“…What is more, it has been noticed that adenocarcinoma that arise from adenomyosis uteri could be present in various histological appearances [ 59 ]. Mahmoud K et al proposed creating other clinical approaches for staging cancers where myoinvasion is found deep in myometrium [ 60 ]. Well described EC-A and EC-AIA pathological pathways do not explain coexistence of both these entities (see red line in Figure 2 ).…”

Section: Clinical Studiesmentioning

confidence: 99%

Adenomyosis as a Risk Factor for Myometrial or Endometrial Neoplasms—Review

Szubert

Koziróg

Wilczyński

2022

IJERPH

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Adenomyosis is a common benign gynecological condition, defined as an extension of endometrial tissue into the myometrium. Some studies suggest that adenomyosis could be a favorable prediction factor associated with survival outcomes in endometrial cancer. The aim of our systematic review was to investigate the current knowledge regarding adenomyosis and a possible molecular mechanism of carcinogenesis in adenomyotic lesions. In addition, the long-term prognosis for patients with endometrial cancer and coexisting adenomyosis (and endometriosis) was a key point of the research. The current literature was reviewed by searching PubMed, using the following phrases: “adenomyosis and endometrial cancer” and “malignant transformation of adenomyosis”. According to the literature, genetic mutations, epigenetic changes, and inactivation of specific tumor suppressor genes in adenomyosis are still poorly understood. Data regarding the influence of adenomyosis on survival outcomes in endometrial cancer seem to be contradictory and require further clinical and molecular investigation.

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Adenomyosis As a Confounder to Accurate Endometrial Cancer Staging

Cited by 19 publications

References 42 publications

Prognostic significance of co‐existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: A meta‐analysis

Prognostic significance of co‐existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: A meta‐analysis

Endometrial Cancer Arising in Adenomyosis That Could Not Be Diagnosed by Endometrial Biopsy: A Case Report

Adenomyosis as a Risk Factor for Myometrial or Endometrial Neoplasms—Review

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