Understanding malignant transformation of endometriosis: imaging features with pathologic correlation

Robinson, Kristin A.; Menias, Christine O.; Chen, Longwen; Schiappacasse, Giancarlo; Shaaban, Akram M.; Caserta, Melanie P.; Elsayes, K.; VanBuren, Wendaline M.; Bolan, Candice W.

doi:10.1007/s00261-019-01914-7

Cited by 44 publications

(30 citation statements)

References 46 publications

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“…The prevalence of ovarian cancer that appears in patients with endometriosis is greater than sporadic ovarian cancer in the general population. Women with endometriosis have an increased risk for certain subtypes of EOC, such as OCCC and EnOC [ 83 , 84 ].…”

Section: Endometriosis and Ovarian Cancer Riskmentioning

confidence: 99%

Wise Management of Ovarian Cancer: On the Cutting Edge

Boussios

Mikropoulos

Samartzis

et al. 2020

JPM

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Epithelial ovarian cancer (EOC) is the fifth leading cause of cancer mortality among women. Two-thirds of patients present at advanced stage at diagnosis, and the estimated 5 year survival rate is 20–40%. This heterogeneous group of malignancies has distinguishable etiology and molecular biology. Initially, single-gene sequencing was performed to identify germline DNA variations associated with EOC. However, hereditary EOC syndrome can be explained by germline pathogenic variants (gPVs) in several genes. In this regard, next-generation sequencing (NGS) changed clinical diagnostic testing, allowing assessment of multiple genes simultaneously in a faster and cheaper manner than sequential single gene analysis. As we move into the era of personalized medicine, there is evidence that poly (ADP-ribose) polymerase (PARP) inhibitors exploit homologous recombination (HR) deficiency, especially in breast cancer gene 1 and 2 (BRCA1/2) mutation carriers. Furthermore, extensive preclinical data supported the development of aurora kinase (AURK) inhibitors in specific tumor types, including EOC. Their efficacy may be optimized in combination with chemotherapeutic or other molecular agents. The efficacy of metformin in ovarian cancer prevention is under investigation. Certain mutations, such as ARID1A mutations, and alterations in the phosphatidylinositol 3-kinase (PI3K)/AKT/mTOR pathway, which are specific in ovarian clear cell carcinoma (OCCC) and endometrioid ovarian carcinoma (EnOC), may offer additional therapeutic targets in these clinical entities. Malignant ovarian germ cell tumors (MOGCTs) are rare and randomized trials are extremely challenging for the improvement of the existing management and development of novel strategies. This review attempts to offer an overview of the main aspects of ovarian cancer, catapulted from the molecular mechanisms to therapeutic considerations.

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Section: Endometriosis and Ovarian Cancer Riskmentioning

confidence: 99%

Wise Management of Ovarian Cancer: On the Cutting Edge

Boussios

Mikropoulos

Samartzis

et al. 2020

JPM

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“…Neometaplasia, known as aberrant differentiation, refers to the germ cell component that arises through a process of transformation of the epithelial precursor neoplasm [6,30]. The most frequently reported epithelial precursor neoplasm is endometrioid carcinoma, which sometimes develops from endometriosis or endometriotic cysts [33]. This is in line with the hypothesis that endometriosis or endometriotic cysts may be a risk factor for YST in postmenopausal women [24].…”

Section: Methodsmentioning

confidence: 88%

Ovarian Yolk Sac Tumor in a Postmenopausal Patient with Malignant Müllerian Mixed Tumor: A Case Report and Systematic Review of the Literature

Zhou

Cheng

et al. 2021

Preprint

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Background Yolk sac tumor (YST) is a most common form of malignant ovarian germ cell tumors and typically occur in young women and adolescent. Ovarian YST occurred in postmenopausal women is an extremely rare entity which has an aggressive behavior and worse outcome. The aim of this article was to provide better understanding of clinicopathological characteristics, management, and prognosis of postmenopausal YSTs.Case presentation A 64-year-old woman was admitted to our hepatobiliary surgery department due to a cystic and solid round mass in the lower right abdomen in December 2013. laboratory tests showed a-fetoprotein (AFP), carcinoembryonic antigen (CEA), and cancer antigen 19-9 (CA19-9) to be within normal limits, but serum cancer antigen (CA-125) was elevated. Exploratory laparotomy was performed including tumorectomy, right oophorectomy, partial omentectomy. Postoperatively, pathologic findings showed that the morphologic features and immunohistochemical results were consistent with ovarian YST with malignant Müllerian mixed tumor (MMMT). The patient was admitted again for recurrence of the tumor and metastasis to bilateral supraclavicular lymph nodes in August 2018. The patient underwent total abdominal hysterectomy (TAH), left salpingo-oophorectomy, right salpingectomy, pelvic lymphadenectomy, and partial peritonectomy. The patient received 6 cycles of adjuvant chemotherapy with BEP (bleomycin, etoposide, and cisplatin) postoperatively, and died of disease in August 2019. Conclusion Here, we presented a case of postmenopausal YST with MMMT. Meanwhile, a systematic literature review was conducted in the PubMed database, including case reports and case series. We summarized the clinical characteristics, treatments, and prognosis of all cases. Overall survival was calculated with Kaplan-Meier curves. Univariate analysis was performed with the log-rank test. A Cox model was constructed to determine independent predictors of mortality. As the morphological and immunophenotypical features of postmenopausal YSTs were always overlapped with somatic epithelial carcinomas, pathologists should have a high index of suspicion to diagnose ovarian YSTs in older women. Optimum chemotherapy is essential in improving prognosis of postmenopausal YSTs.

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“…19 This would minimally include T2 small field of view in three planes, T1 weighed imaging with fat-saturation in the axial and sagittal planes and dynamic post-contrast imaging with glucagon to assess for signal characteristics which may relate to hemorrhage (T1 hyperintense) or fibrosis (T2 hypointense) and to look for potential areas of intrapelvic involvement, aiding in treatment planning. Features of malignant degeneration may also be evaluated, 20 cases of which have previously been described in the literature. 21 Often desmoid tumors may have a similar appearance to AWE on imaging, and biopsy prior to or during therapy may be warranted.…”

Section: Discussionmentioning

confidence: 99%

Nonsurgical radiologic intervention for management of abdominal wall endometriosis: A systematic review and meta-analysis

Cope

Narasimhulu

Khan

et al. 2020

Journal of Endometriosis and Pelvic Pain Disorders

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Objective: To describe reported outcomes of nonsurgical radiologic interventions for abdominal wall endometriosis in comparison with surgery where available. Data sources: A systematic search of Ovid Medline, Embase, PubMed, and Cochrane Controlled Register of Trials was performed from inception to January 2019 with no language restrictions. Study eligibility criteria: Studies were included if they evaluated a nonsurgical intervention in women with symptomatic abdominal wall endometriosis with both comparative and noncomparative study designs. Study appraisal and synthesis methods: Titles and abstracts were reviewed for relevance, and full-text articles were obtained and evaluated for inclusion, all in duplicate. Meta-analysis was performed when possible using a fixed effects model. Results: Of the 114 records reviewed, 16 full-text articles were assessed and 7 were included in analysis. The standard mean difference between pre- and post-intervention pain scores was similar between ultrasound-guided high-intensity focused ultrasound (USgHIFU) (−3.00; 95% confidence interval −3.34, −2.66) and cryoablation (−3.93; 95% confidence interval −5.73, −2.12). The mean percent decrease in lesion size following intervention was similar between USgHIFU (−61.38%; 95% confidence interval −78.64%, −44.11%), and cryoablation (−88.16%; 95% confidence interval −83.90%, −55.06%). When compared with surgical excision, mean length of stay was 2.78 days less in the nonsurgical intervention group (95% confidence interval −3.78, −1.79). Conclusions: Both USgHIFU and cryoablation are effective at reducing pain scores and lesion size in abdominal wall endometriosis. Mean length of stay was significantly less following a nonsurgical radiologic intervention for abdominal wall endometriosis compared with surgery. More studies are needed comparing complication and recurrence rates between nonsurgical radiologic interventions for abdominal wall endometriosis and surgery.

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Understanding malignant transformation of endometriosis: imaging features with pathologic correlation

Cited by 44 publications

References 46 publications

Wise Management of Ovarian Cancer: On the Cutting Edge

Wise Management of Ovarian Cancer: On the Cutting Edge

Ovarian Yolk Sac Tumor in a Postmenopausal Patient with Malignant Müllerian Mixed Tumor: A Case Report and Systematic Review of the Literature

Nonsurgical radiologic intervention for management of abdominal wall endometriosis: A systematic review and meta-analysis

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