Prognostic importance of atypical endometriosis with architectural hyperplasia versus cytologic atypia in endometriosis-associated ovarian cancer

Abstract

Objective Patients with endometriosis are at increased risk of ovarian cancer. It has been suggested that atypical endometriosis is a precursor lesion of endometriosis-associated ovarian cancer (EAOC). The aim of this study is to evaluate if cytologic (cellular) atypia and architectural atypia (hyperplasia), histologic findings described as atypical endometriosis, play a different role in patients with EAOC. Methods A prospective study was conducted between January 2014 and April 2017 at our institution with patients undergoing surgery with a histologic diagnosis of endometriosis, ovarian cancer, or EAOC. The prevalence and immunohistologic study (Ki-67, BAF250a, COX-2) of cases of cellular and architectural atypia in endometriosis were analyzed. Results Two hundred and sixty-six patients were included: the diagnosis was endometriosis alone in 159 cases, ovarian cancer in 81, and EAOC in 26. Atypical endometriosis was reported in 23 cases (12.43%), 39.13% of them found in patients with EAOC. Endometriosis with cellular atypia was found mainly in patients without neoplasm (71.4%), and endometriosis with architectural atypia was seen in patients with ovarian cancer (88.9%) (p=0.009). Ki-67 was significantly higher in endometriosis patients with architectural atypia than those with cellular atypia. Conclusion The diagnosis of endometriosis with architectural atypia is important because it may be a precursor lesion of ovarian cancer; therefore, pathologists finding endometriosis should carefully examine the surgical specimen to identify any patients with hyperplasia-type endometriosis, as they may be at higher risk of developing EAOC.

Ovarian endometriosis, a precursor of ovarian cancer: Histological aspects, gene expression and microRNA alterations (Review)

“…The presence and increased number of cases of atypical endometriosis, considered by several studies as an intermediate lesion between endometriosis and ovarian malignancy, may allow the identification of endometrial lesions at risk for malignant transformation ( 28 , 77 , 78 ). Since endometriosis is frequently observed in association with endometrioid and clear cell ovarian carcinoma, or in another perspective ovarian cancer arises from endometriosis, it can be hypothesized that endometriosis may be viewed as a preneoplastic or neoplastic process ( 36 ).…”

Malignant Transformation and Associated Biomarkers of Ovarian Endometriosis: A Narrative Review

“…The most quoted two theories of endometrial implantation assume either that endometrial cells reflux or that retrograde menstruation involving the fallopian tubes results in implantation and proliferation elsewhere [ 6 – 8 ]. While both theories are plausible, they have weaknesses.…”

“…The classical role of estrogen and the great importance of paracrine and autocrine mechanisms are well established [ 1 – 4 ]. Importantly, endometriosis is a known risk factor for ovarian cancer [ 5 ] and can transform to atypical form and even undergo malignant transformation in 0.7–2.5% of cases [ 6 , 7 ]. All electronic searches were conducted on four different electronic databases (MEDLINE, Scopus, Embase, and PubMed) to retrieve relevant studies conducted over the last 30 years.…”

Endometriosis and ovarian cancer - what they have in common?

“…Some analyses describe endometriosis as a risk factor for ovarian cancer [1]. The standpoint that atypical endometriosis is a direct precursor for ovarian cancer becomes generally accepted nowadays [21]. Atypical endometriosis is characterized by architectural proliferation and increase in nuclear/cytoplasmic ratio [2].…”