Several previous studies have identified an association between endometriosis and the development of ovarian carcinomas.
This study aims to follow-up the prevalence of endometriosis and the histological features in ovarian tumors.
Materials and method. The study group included 50 patients from the County Emergency Hospital of Galaţi diagnosed with different histological types of ovarian tumors of the surface epithelium during the period The cases were reviewed in order to highlight the presence of endometriosis and the different histopathological changes. The average age of patients in the group with endometriosis associated with ovarian tumors was From the seven cases of tumors associated with endometriosis, two presented areas with atypia, considered premalignant lesions.
Based on data obtained, we can conclude that endometriosis endometrial cancer type 1 and 2 atypia can be a precursor to the occurrence of type I ovarian carcinomas. Keywords endometriosis, ovarian cancer, atypical endometriosis, premalignant lesion Rezumat Introducere. Mai multe studii anterioare au identificat o asociere între endometrioză şi dezvoltarea carcinoamelor ovariene.
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- Incidenţa endometriozei şi a endometriozei atipice în cazul tumorilor ovariene epiteliale
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Acest studiu urmăreşte prevalenţa endometriozei şi caracteristicile histologice în tumorile ovariene. Materiale şi metodă. În lotul de studiu endometrial cancer type 1 and 2 fost incluse 50 de paciente diagnosticate cu diferite tipuri histologice de tumori ovariene ale epiteliului de suprafaţă în perioada la Spitalul Judeţean de Urgenţă din Galaţi.
Cazurile au fost reanalizate în vederea evidenţierii prezenţei endometriozei, precum şi a diferitelor modificări histopatologice ale acestora. Vârsta medie a pacientelor a fost 59,4±11,35 ani în lotul pacientelor care au prezentat endometrioză asociată şi 59,5±13,4 ani în lotul pacientelor care au prezentat doar tumori ovariene.
HISTOPATHOLOGICAL DIAGNOSIS CRITERIA IN ENDOMETRIAL HYPERPLASIA
Din cele şapte cazuri de endometrioză, în două cazuri au fost evidenţiate zone cu atipii, considerate leziuni premaligne. Identificarea endometriozei cu atipii la cele două cazuri — unul diagnosticat endometrial cancer type 1 and 2 carcinom cu celule clare, iar celălalt cu carcinom endometrial, ambele incluse în tipul I de cancer ovarian — demonstrează faptul că endometrioza cu atipii poate fi un precursor în apariţia carcinoamelor ovariene de tip I. Endometriosis is a gynecological condition, being characterized from a histopathological point of view by the presence of glandular structures at the level of the endometrium and stroma in ectopic locations, such as ovary, pelvis, bladder, Fallopian tube, ovary representing the most common location 4,5.
The literature comprises multiple studies highlighting the link between the presence of endometriosis and its malignant transformation in the ovary, although other studies have not identified associations between these two 6,7. It is estimated that the risk of malignant transformation of endometriosis endometrial cancer type 1 and 2 comprised between 0.
Incidenţa endometriozei şi a endometriozei atipice în cazul tumorilor ovariene epiteliale
Endometriosis with atypia is described as a preneoplastic lesion and is considered an intermediate pathway for the development of ovarian carcinoma 3. InSampson described for the first time the implications of endometriosis in neoplastic lesions by endometrial cancer type 1 and 2 several important criteria: the presence of endometriosis and the tumor in the same ovary, a similar histological pattern, the exclusion of the presence of tumor metastasis from other locations 8.
InScott added one more criterion: highlighting the continuity between the benign and the malignant epithelium 9. Atypia from endometriosis was proposed as a preneoplastic lesion between endometriosis and ovarian cancer, as it refers to two major endometrial cancer type 1 and 2 changes: cytological atypia and architectural atypia known as hyperplasia Cytological atypia is highlighted in the epithelium of an endometrial cyst, while the hyperplasia resembles to the hyperplasia present in the endometrium simple or complex with or without atypia Materials and method The study comprises patients of the Emergency County Hospital of Galaţi diagnosed with ovarian carcinoma during the period January — December The histopathological results were endometrial cancer type 1 and 2 retrospectively to identify the presence of endometriosis.
A number of diagnosed cases and ovarian tumors were analyzed in order to identify the presence or absence of endometriosis, as well as the relationship between these two, based on the criteria listed before.
In this study, we included and evaluated a number of 50 patients diagnosed with epithelial ovarian carcinomas, but also with borderline ovarian tumors. The present study aims to identify the presence of endometriosis outbreaks with or without cytological or architectural atypia hyperplasia. Each case was evaluated from a histopathological point of view.
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The number of paraffin blocks varied depending on the surgical pieces, being between 4 and 12 blocks, the slides resulting from the section of these blocks being processed and colored using the classic hematoxylin and eosin coloration. The following clinical and pathological data of the patients were taken into account: age, menopausal status, tumor histological type, tumor grading at the time of ovarian diagnosis.
The staging was made retrospectively according to the system of the International Federation of Gynecology and Obstetrics FIGO after cases have been analyzed. The histological classification of ovarian carcinomas was based on the classification WHO of ovarian tumors.
Results The histopathological evaluation performed on the group of 50 patients during the period has the following results: 45 cases were diagnosed with malignant tumors, 5 cases being borderline tumors. Figure 1. Figure 2.
From the seven patients with endometriosis, None of the cases of borderline mucinous tumors, mucinous carcinoma, and undifferentiated carcinoma presented associated endometriosis outbreaks Table 1. Table 1.
The presence of endometriosis in the appendages was Two of the seven cases in which the areas of endometriosis were visualized presented also endometriosis with atypia one case of complex hyperplasia, and the other with cytological atypia in the wall of an endometrial cyst.
In our study, the average age at the moment of diagnosis was Endometrial cancer type 1 and 2 of the studies reported in the literature identified an average age of The association between endometriosis and ovarian cancer is reported in the expert studies under two categories.
Tumor markers in endometrial cancer
In all other cases, the ovarian tumor literally coexisted with endometriosis without the identification of a transition 13, Ogawa et al. In this study, the transition between endometriosis and ovarian carcinoma endometrial cancer type 1 and 2 present only in two cases, representing According to the classification proposed by Kurman and Shih, all identified ovarian tumors were classified into two large groups: type I and type II. Type I contains low-grade serous carcinoma, endometrioid carcinomas, clear cell carcinomas, mucinous carcinomas, and transitional type endometrial cancer type 1 and 2, while in type II the ovarian tumors are comprising high-grade serous carcinoma, mixed malignancies and undifferentiated carcinomas Most studies on this topic show that endometrial cancer type 1 and 2 prevalence of endometriosis is higher in endometrial cancer type 1 and 2 case of endometrioid carcinomas and especially those with clear cells compared to the mucinous and serous carcinomas 2,5,12, Another study showed hpv impfung welcher arzt This study comprises also an evaluation of the presence or absence of endometriosis in patients with ovarian tumors and the transition between endometriosis outbreaks and ovarian tumors.
According to a study by Van Gorp et al.
Cancer endometrial - Wikipedia
Category A consists of cases with areas of endometriosis present in the same ovary, with areas of histological transition between endometriosis and ovarian tumor. Category B contains cases with outbreaks of endometriosis without transition between endometriosis and tumor, while category C contains cases with endometriosis present in any other location, for example in the pelvis, the contralateral ovary in extragonadal endometriosis 5.
In our study, from the seven cases of carcinomas presenting endometriosis outbreaks associated, in two cases there were highlighted areas of transition between the benign and the malignant process identified by the criteria listed by Sampson and Scott, and included in category A. From the five cases, the remaining four were classified in category B, and one case in category C. The presence of areas of endometriosis with atypia was made based on criteria which included the increase in volume or hyperchromatic of nuclei, or contrary, hypochromic nuclei, eosinophilic cytoplasm, branching and agglomeration or stratification, all according to the criteria suggested by LaGrenada and Silverberg The study is limited due to the low number of cases for some of the histological types.
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- Tumor markers in endometrial cancer
Conclusions Endometrioid and clear cell carcinoma are the most common types of tumors in association with endometriosis included in type I tumors, according to the classification proposed by Kurman and Shih.
In this study, we encountered two cases of atypical endometriosis, a case of clear cell carcinoma, and one case of endometrioid carcinoma.
In both cases, we observed the transition from a preneoplastic lesion to the neoplastic lesion, which makes us think that endometriotic atypia can be considered a precursor to type I carcinomas. Conflict of interests: The authors declare no conflict of interests.
The molecular signature of endometriosis-associated endometrioid ovarian cancer differs significantly from endometriosis-independent endometrioid ovarian cancer. Fertil Steril. Clinical analysis of ovarian epithelial carcinoma with coexisting pelvic endometriosis. Am J Obstet Gynecol. Munksgaard PS, Blaakaer J. The association between endometriosis and ovarian cancer: a review of histological, genetic and molecular alterations.
Clinical , histopathological and immunohistochemical study of endometrial carcinomas
Gynecol Oncol. Endometriosis-associated ovarian cancer: a review of pathogenesis. Int J Mol Sci. Endometriosis and the development of malignant tumours of the pelvis.
A review of literature.
Kokcu A. Relationship between endometriosis and cancer from current perspective.
Incidence of endometriosis and atypical endometriosis in epithelial ovarian tumors
Arch Gynecol Obstet. Association between endometriosis and cancer: a comprehensive review and a critical analysis of clinical and epidemiological evidence. Histologic transformation of benign endometriosis to early epithelial ovarian cancer.
Aim: To highlight the value of histopathological examinations with assessment of the ways to obtain endometrial biopsies and the appreciation of the contribution of different histopathological techniques that can be used to establish a correct and complete diagnosis. Material and methods: The study was conducted in a group of 50 patients diagnosed with endometrial hyperplasia. In all cases the bioptic curettage was performed using a curette to obtain more endometrial cancer type 1 and 2 material for the histopathological examination. Results: Histopathological diagnosis guides the therapeutic attitude and has an important prognostic value.
Perspectives et implications cliniques. Gynécologie Obstétrique Fertil. Ovarian tumors associated with atypical endometriosis. Hum Pathol.