Clinical Characteristics of Patients in Japan with Ovarian Cancer Presumably Arising from Ovarian Endometrioma

Abstract

Objective: To investigate the clinical features of patients in Japan with malignant transformation of ovarian endometrioma. Patients: Thirty-three patients diagnosed with ovarian cancer presumably arising from endometrioma were recruited retrospectively. These patients had been followed for at least 2 years after the ovarian endometrioma diagnosis, then continued to be followed after they had been found to have malignant transformation. Results: The average age of the patients was 47.7 ± 9.3 years; 75.7% were premenopausal at the time of diagnosis of ovarian cancer. Among the 33 patients, ovarian cancer developed in the ipsilateral ovary of 6 patients with endometrioma after cystectomy. Twenty-eight patients were diagnosed with stage I ovarian cancer, and major histotypes were clear cell in 23 cases and endometrioid in 8. Before surgery for cancer, mural nodules within the endometriomas were detected in 32 patients, and 1 patient had a small 3-mm nodule. In 30 patients, the diameter of the tumor doubled in size 6 months prior to the diagnosis of malignant transformation. The diameter of the endometrioma and the preoperative CA125 value did not significantly correlate. Conclusions: To detect malignant transformation of ovarian endometrioma early and precisely, the clinician should determine the existence of a mural nodule and assess the rapid growth of the endometrioma.

Epithelial Ovarian Cancers and Endometriosis

“…In our study, 50% of endometriosis-associated EOC cases were FIGO I-stage, and was also more common in low grade or borderline tumors. Several studies have reported a more benign character of the tumor when endometriosis is present [8,9,10,24,29,34,35] with better survival rates (as shown in fig. 1).…”

“…Besides, Ogawa et al [14] described 43 patients who had clear cell carcinoma and only 7 cases of endometrioid carcinoma, which confirms the great variability that is found in the histological classifications, both in the subtype of carcinoma and the subtype of endometriosis. But it has to be taken into account that the prevalence of clear cell EOC in Japan [34] seems to be much higher than that in western countries for unknown reasons. In our study, the few cases of atypical endometriosis that were associated with EOC were observed in endometrioid carcinomas, but no differences were observed between typical (with or without p53 expression) and atypical endometriosis in the clinical variables analyzed.…”

“…Recently, Taniguchi et al [34] have analyzed the clinical characteristics of 33 patients diagnosed with ovarian cancer presumably arising from ovarian endometrioma. The diameter of the endometrioma and the preoperative CA-125 value did not significantly correlate.…”

Different Patterns of Disease Spread between Advanced-Stage Type I and II Epithelial Ovarian Cancer

“…It is widely accepted that type I tumors, in particular those of endometrioid and clear-cell histology, are strongly linked to endometriosis [9,10,11], which may involve the ovary after the implantation of endometrial fragments via retrograde menstruation. Several studies have raised the hypothesis of an ‘altered' endometrial cell to be considered the original precursor of type I ovarian tumors: it has already been found that the eutopic endometrium of those women affected by endometriosis is characterized by molecular alterations that may presumably allow the ‘altered' endometrial cell to spread toward ovarian tissue [11,12]. Consistent with this evidence is the higher rate of synchronous endometrial cancers found in patients with endometriosis-associated endometrioid ovarian carcinomas [9].…”

Laparoscopic Splenectomy as Quaternary Cytoreduction for Isolated Parenchymal Splenic Recurrence of Epitelial Tubo-Ovarian Cancer: Report of a Case and Literature Review

“…Primary epithelial tubo-ovarian cancer (ETOC) is a complex and heterogeneous group of tumors that remain the most deadly of all gynecologic malignancies [1]. Isolated recurrence in splenic parenchyma in patients with ETOC is extremely rare in the absence of apparent disease at other sites.…”