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Zhou C, Luo X, Tang M, Luo F, Liao Z. A rare case of concomitant endometrioid adenocarcinoma arising from uterine adenomyosis and clear cell carcinoma arising from parametrial deep endometriosis. BMC Womens Health 2024; 24:440. [PMID: 39090585 PMCID: PMC11295390 DOI: 10.1186/s12905-024-03170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/28/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Carcinomatous changes from the ectopic endometrial glands in endometriosis have been reported in many studies, but malignant transformation from uterine adenomyosis/adenomyoma is rare. And clear cell-like adenocarcinoma represents a seldom-encountered malignant pathological variant of ectopic endometrium. CASE PRESENTATION This case report presents a case of a 44-year-old nulliparous woman begun with abdominal pain and intestinal obstruction. Past medical history showed laparoscopic ovarian endometriotic cyst excision. Ultrasound indicated adenomyoma and a parametrial hypoechoic nodule with abundant blood flow signals and unclear boundaries. Deep invasive endometriosis was considered preoperatively. The patient underwent laparoscopic subtotal hysterectomy and bilateral adnexa resection. Chocolate cyst-like lesion was observed in the parametral lesion. Postoperative pathological examinations suggested endometrioid adenocarcinoma arising from eutopic endometrium and adenomyoma. Ectopic endometrium in the myometrium combined with atypical hyperplasia and formation of endometrioid adenocarcinoma. Left parametrial lesions suggested poorly differentiated endometrioid adenocarcinoma combined with clear cell carcinoma. CD10 + endometrial stromal cells were observed surrounding tumor cell masses. Combined with surgical founding and pathological characters of the left parametrial adenocarcinoma, the parametrial lesions were more likely to be carcinomatous changes of the original deep endometriosis.The patient underwent subsequent transabdominal tumor cell reduction surgery and chemotherapy. CONCLUSION We herein present a rare case of combined endometrioid adenocarcinoma arising from uterine adenomyosis and clear cell carcinoma arising from parametrial deep endometriosis that may help inspire additional studies in the future. The patient underwent robot-assisted laparoscopic subtotal hysterectomy, bilateral adnexa resection, deep endometriosis lesion resection and bilateral ureteral stent placement. Following surgery, a chemotherapy regimen of Taxol and Carboplatin was administered.
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Affiliation(s)
- Cailu Zhou
- Southwest Medical University, Luzhou, 646099, China
| | - Xiaojing Luo
- University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Mengjie Tang
- University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Fangyuan Luo
- Department of Obstetrics and Gynecology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Zhi Liao
- Southwest Medical University, Luzhou, 646099, China.
- University of Electronic Science and Technology of China, Chengdu, 610054, China.
- Department of Obstetrics and Gynecology, Sichuan Provincial People's Hospital, Chengdu, 610072, China.
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2
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Hoshiba N, Kayahashi K, Hayashi S, Nomura S, Nakayama M, Iizuka T, Fujiwara H. Occult clear cell carcinoma arising from oxidative stress‑exposed cystic adenomyosis: A case report. Mol Clin Oncol 2024; 21:50. [PMID: 38872950 PMCID: PMC11170329 DOI: 10.3892/mco.2024.2748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Although adenomyosis is a benign uterine disease, it can turn malignant in rare instances. Cystic adenomyosis is a rare variation of adenomyosis, arising from which 8 cases of clear cell carcinoma have been reported. However, to the best of our knowledge, there have been no previous reports describing the mechanism by which clear cell carcinoma develops from cystic adenomyosis. The present report documents a case of a 73-year-old woman who was referred to Kanazawa University Hospital (Kanazawa, Japan) because of cystic adenomyosis, with a solid part inside the cyst. The patient was diagnosed with cystic adenomyosis at Shonan Obstetrics and Gynecology Hospital (Hakusan, Japan) 17 years prior; however, the size of the cyst increased after menopause. Therefore, malignant transformation was suspected, which warranted simple abdominal hysterectomy and bilateral salpingo-oophorectomy. The final diagnosis of the present case was uterine corpus cancer, clear cell carcinoma, stage IA. Immunohistochemical staining revealed that the normal and transitional atypical epithelial cells lining the cyst wall, in addition to the clear cell carcinoma cells (which were inside mural nodules located on the cyst wall), were positive for 8-hydroxy-20-deoxyguanosine. This observation suggested the presence of chronic oxidative stress around the cystic adenomyosis. Therefore, the present case suggests the possible involvement of chronic oxidative stress in the malignant transformation of cystic adenomyosis to clear cell carcinoma. This mechanism of malignant transformation of cystic adenomyosis appears to be similar to that of the malignant transformation of endometriotic cysts. Therefore, if the size of the cystic adenomyosis increases after menopause or if the solid part appears in the cyst in future cases, then the possibility of malignant transformation should be considered.
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Affiliation(s)
- Nao Hoshiba
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Kayo Kayahashi
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Sakura Hayashi
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Satoshi Nomura
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Midori Nakayama
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Takashi Iizuka
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Hiroshi Fujiwara
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
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3
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Oyama Y, Kusaba T, Takao K, Obata E, Yano M, Kawamura K, Nishida H, Daa T. Alpha-fetoprotein producing endometrioid carcinoma arising in an adenomyoma of the uterus. Med Mol Morphol 2024:10.1007/s00795-024-00384-1. [PMID: 38466424 DOI: 10.1007/s00795-024-00384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/14/2024] [Indexed: 03/13/2024]
Abstract
We report a case of alpha-fetoprotein-producing endometrioid carcinoma (AFP-EC) that originated within an adenomyoma of the uterine corpus. A 76-year-old Japanese woman was incidentally discovered to have a uterine tumor along with multiple lung nodules. Upon surgical removal of the uterus, it was revealed that the tumor was situated within the adenomyoma. The tumor exhibited microfollicular structures and solid growth patterns, with hyaline globules, clear cell glands, and primitive tumor cells. Immunohistochemical analysis indicated the presence of germ cell markers, including AFP, SALL4, and glypican3, leading to final diagnosis of AFP-EC. Histopathologically, AFP-ECs exhibit characteristics similar to those of AFP-producing neoplasms in other organs. Furthermore, a nomenclature issue arises when distinguishing AFP-ECs from yolk sac tumors of the endometrium in older patients due to their shared features. The concept of retrodifferentiation or neometaplasia suggests that "endometrioid carcinoma with yolk sac tumor differentiation" or "endometrioid carcinoma with a primitive phenotype" may serve as more fitting terms for the diverse spectrum of AFP-producing neoplasms in the endometrium. In conclusion, this case underscores the diagnostic challenges posed by AFP-ECs arising from adenomyomas and emphasizes the need for refining the nomenclature and classification of AFP-producing neoplasms within the endometrium.
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Affiliation(s)
- Yuzo Oyama
- Faculty of Medicine, Department of Diagnostic Pathology, Oita University, 1-1, Idaigaoka, Hasama-Machi, Yufu, 879-5593, Japan
| | - Takahiro Kusaba
- Faculty of Medicine, Department of Diagnostic Pathology, Oita University, 1-1, Idaigaoka, Hasama-Machi, Yufu, 879-5593, Japan
| | - Kasumi Takao
- Faculty of Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Eri Obata
- Faculty of Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Mitsutake Yano
- Faculty of Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kazuhiro Kawamura
- Faculty of Medicine, Department of Diagnostic Pathology, Oita University, 1-1, Idaigaoka, Hasama-Machi, Yufu, 879-5593, Japan
| | - Haruto Nishida
- Faculty of Medicine, Department of Diagnostic Pathology, Oita University, 1-1, Idaigaoka, Hasama-Machi, Yufu, 879-5593, Japan.
| | - Tsutomu Daa
- Faculty of Medicine, Department of Diagnostic Pathology, Oita University, 1-1, Idaigaoka, Hasama-Machi, Yufu, 879-5593, Japan
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Istrate-Ofiţeru AM, Mogoantă CA, Zorilă GL, Roşu GC, Drăguşin RC, Berbecaru EIA, Zorilă MV, Comănescu CM, Mogoantă SȘ, Vaduva CC, Brătilă E, Iliescu DG. Clinical Characteristics and Local Histopathological Modulators of Endometriosis and Its Progression. Int J Mol Sci 2024; 25:1789. [PMID: 38339066 PMCID: PMC10855449 DOI: 10.3390/ijms25031789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Endometriosis (E) and adenomyosis (A) are associated with a wide spectrum of symptoms and may present various histopathological transformations, such as the presence of hyperplasia, atypia, and malignant transformation occurring under the influence of local inflammatory, vascular and hormonal factors and by the alteration of tumor suppressor proteins and the inhibition of cell apoptosis, with an increased degree of lesion proliferation. MATERIAL AND METHODS This retrospective study included 243 patients from whom tissue with E/A or normal control uterine tissue was harvested and stained by histochemical and classical immunohistochemical staining. We assessed the symptomatology of the patients, the structure of the ectopic epithelium and the presence of neovascularization, hormone receptors, inflammatory cells and oncoproteins involved in lesion development. Atypical areas were analyzed using multiple immunolabeling techniques. RESULTS The cytokeratin (CK) CK7+/CK20- expression profile was present in E foci and differentiated them from digestive metastases. The neovascularization marker cluster of differentiation (CD) 34+ was increased, especially in areas with malignant transformation of E or A foci. T:CD3+ lymphocytes, B:CD20+ lymphocytes, CD68+ macrophages and tryptase+ mast cells were abundant, especially in cases associated with malignant transformation, being markers of the proinflammatory microenvironment. In addition, we found a significantly increased cell division index (Ki67+), with transformation and inactivation of tumor suppressor genes p53, B-cell lymphoma 2 (BCL-2) and Phosphatase and tensin homolog (PTEN) in areas with E/A-transformed malignancy. CONCLUSIONS Proinflammatory/vascular/hormonal changes trigger E/A progression and the onset of cellular atypia and malignant transformation, exacerbating symptoms, especially local pain and vaginal bleeding. These triggers may represent future therapeutic targets.
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Affiliation(s)
- Anca-Maria Istrate-Ofiţeru
- Department of Histology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.-M.I.-O.); (G.-C.R.)
- Research Centre for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (R.C.D.); (D.G.I.)
| | - Carmen Aurelia Mogoantă
- ENT Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - George-Lucian Zorilă
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (R.C.D.); (D.G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Gabriela-Camelia Roşu
- Department of Histology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.-M.I.-O.); (G.-C.R.)
- Research Centre for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Roxana Cristina Drăguşin
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (R.C.D.); (D.G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | | | - Marian Valentin Zorilă
- Department of Forensic Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | | | | | - Constantin-Cristian Vaduva
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Elvira Brătilă
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Dominic Gabriel Iliescu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (R.C.D.); (D.G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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5
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Shahnazari R, Shirzadi S, Karaji S, Mokhles P, Far MJG, Maghsudlu S. Endometrial cancer arising from adenomyosis with unusual manifestation: A case report. Clin Case Rep 2024; 12:e8353. [PMID: 38161634 PMCID: PMC10753132 DOI: 10.1002/ccr3.8353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/16/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024] Open
Abstract
Endometrial Carcinoma Arising from Adenomyosis (EC-AIA) is an unusual condition, primarily occurring in postmenopausal women. We present a rare case of a 34-year-old woman with EC-AIA, highlighting the diagnostic challenges in distinguishing this malignancy from adenomyosis preoperatively. Conventional imaging methods exhibited limitations, necessitating post-surgery confirmation through comprehensive examinations. The case emphasizes the need for a multidisciplinary approach for accurate diagnosis and timely management in such uncommon gynecological conditions.
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Affiliation(s)
- Razieh Shahnazari
- Fellowship in Obstetrics & GYN Imaging, Firoozabadi Clinical Research Development Unit (FACRDU), Department of Radiology, School of MedicineIran University of Medical SciencesTehranIran
| | - Shahriar Shirzadi
- Department of RadiologyHamedan University of Medical SciencesHamedanIran
| | - Sina Karaji
- Department of RadiologyIran University of Medical SciencesTehranIran
| | - Parisa Mokhles
- Department of Pathology, School of MedicineIran University of Medical ScienceTehranIran
| | - Mohamad Javad Ghafouri Far
- Department of Radiology, School of Medicine, Rasool Akram hospitalIran university of medical sciencesTehranIran
| | - Salome Maghsudlu
- Department of RadiologyTehran University of Medical SciencesTehranIran
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6
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Ong WLL, Lau LC. Clinics in diagnostic imaging (217). Singapore Med J 2023; 64:629-633. [PMID: 37861644 PMCID: PMC10645012 DOI: 10.4103/singaporemedj.smj-2021-336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/18/2022] [Indexed: 10/21/2023]
Affiliation(s)
- Wu Lin Low Ong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Li Ching Lau
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
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7
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Wang DG, Ji LM, Jia CL, Shao MJ. Effect of coexisting adenomyosis on tumour characteristics and prognosis of endometrial cancer: A systematic review and meta-analysis. Taiwan J Obstet Gynecol 2023; 62:640-650. [PMID: 37678989 DOI: 10.1016/j.tjog.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 09/09/2023] Open
Abstract
To compare clinicopathological features and survival outcomes in patients with endometrial cancer, with and without associated adenomyosis. PubMed, Embase and Scopus databases were systematically searched for relevant observational studies. The pooled effect sizes were reported as either hazards ratio (HR) for survival-related outcomes or as odds ratio (OR) for other categorical outcomes. Weighted mean difference (WMD) was reported for continuous outcomes. All the analyses used the random effects model. A total of 21 studies (N = 46,420) were included. Compared to endometrial cancer patients without adenomyosis, patients with associated adenomyosis had improved overall 5-year survival (OS) (HR 0.62, 95% CI: 0.50, 0.79) and disease-free survival (DFS) (HR 0.60, 95% CI: 0.44, 0.82). Disease-specific survival was statistically similar in patients with and without adenomyosis (HR 0.60, 95% CI: 0.35, 1.05). Among patients with adenomyosis, the risk of having an advanced tumour grade (Grade 2 or 3) was lower (OR 0.51, 95% CI: 0.42, 0.62) and a risk of having International Federation of Gynaecology and Obstetrics (FIGO) stage I or II was higher (OR 2.23, 95% CI: 1.65, 3.01). Patients with adenomyosis had lower risk of tumour invasion of adnexa, cervical stromal invasion, deep myometrial involvement (DMI), lympho-vascular space invasion (LVSI) and peritoneal invasion. Presence of adenomyosis in patients with endometrial cancer is associated with favourable tumour characteristics and may improve the survival.
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Affiliation(s)
- Dong-Ge Wang
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, China
| | - Li-Mei Ji
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, China
| | - Cen-Lin Jia
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, China
| | - Ming-Jun Shao
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, China.
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Şimşek E, Yıldız Ş, Karakaş S, Gündüz S, Yıldız ÖA, Özdemir İA, Yaşar L. Effect of adenomyosis on prognosis of patients with endometrial cancer. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221720. [PMID: 37466591 DOI: 10.1590/1806-9282.20221720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Our goal was to contrast the prognoses of patients with endometrial cancer who had adenomyosis against those that did not. METHODS All patients who had received surgical staging for hysterectomy-based endometrial cancer had their medical data retrospectively examined. The analysis covered 397 patients, who were split into two groups depending on the presence of adenomyosis. Comparisons were made between patients covering type of surgery, histopathology, endometrial cancer stage, lymphovascular space invasion, presence of biochemical or histochemical markers, adjuvant therapy, presence of adenomyosis in the myometrial wall, and outcomes in terms of overall survival and disease-free survival. RESULTS There is no statistically significant difference in the 5-year disease-free survival or overall survival rates between endometrial cancer patients with and without adenomyosis. This is based on comparisons of tumor stage, tumor diameter, histological type and grade of tumor, myometrial invasion, lymphovascular space invasion, and biochemical markers that affect the course of the disease. The median follow-up times were 61 months for the adenomyosis-positive group and 56 months for the group without adenomyosis. CONCLUSION Coexisting adenomyosis in endometrial cancer has no bearing on survival rates and is not a prognostic factor.
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Affiliation(s)
- Erkan Şimşek
- University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology - Istanbul, Turkey
| | - Şükrü Yıldız
- University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology - Istanbul, Turkey
| | - Sema Karakaş
- University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology - Istanbul, Turkey
| | - Sadık Gündüz
- University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology - Istanbul, Turkey
| | - Özge Akdeniz Yıldız
- University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology - Istanbul, Turkey
| | - İsa Aykut Özdemir
- Istanbul Medipol University, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology - Istanbul, Turkey
| | - Levent Yaşar
- University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology - Istanbul, Turkey
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9
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Paris V, Cola E, Santoni M, Pioli F, Piermartiri MG, Orici F, Pelagalli M. A tricky case of endometrial cancer arising from adenomyosis. Eur J Obstet Gynecol Reprod Biol 2023; 285:212-213. [PMID: 37127477 DOI: 10.1016/j.ejogrb.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/20/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Affiliation(s)
- V Paris
- ASUR Marche, Department of Obstetrics and Gynecology, Macerata Hospital, Italy.
| | - E Cola
- ASUR Marche, Department of Obstetrics and Gynecology, Macerata Hospital, Italy
| | - M Santoni
- ASUR Marche, Oncology Unit, Macerata Hospital, Italy
| | - F Pioli
- ASUR Marche, Department of Obstetrics and Gynecology, Macerata Hospital, Italy
| | - M G Piermartiri
- ASUR Marche, Department of Obstetrics and Gynecology, Macerata Hospital, Italy
| | - F Orici
- ASUR Marche, Department of Obstetrics and Gynecology, Macerata Hospital, Italy
| | - M Pelagalli
- ASUR Marche, Department of Obstetrics and Gynecology, Macerata Hospital, Italy
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10
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Moraru L, Mitranovici MI, Chiorean DM, Moraru R, Caravia L, Tiron AT, Cotoi OS. Adenomyosis and Its Possible Malignancy: A Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13111883. [PMID: 37296736 DOI: 10.3390/diagnostics13111883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Cancer arising from adenomyosis is very rare, with transformation occurring in only 1% of cases and in older individuals. Adenomyosis, endometriosis and cancers may share a common pathogenic mechanism that includes hormonal factors, genetic predisposition, growth factors, inflammation, immune system dysregulation, environmental factors and oxidative stress. Endometriosis and adenomyosis both exhibit malignant behaviour. The most common risk factor for malignant transformation is prolonged exposure to oestrogens. The golden standard for diagnosis is histopathology. Colman and Rosenthal emphasised the most important characteristics in adenomyosis-associated cancer. Kumar and Anderson emphasised the importance of demonstrating a transition between benign and malignant endometrial glands in cancer arising from adenomyosis. As it is very rare, it is difficult to standardize treatment. In this manuscript, we try to emphasize some aspects regarding the management strategy, as well as how heterogenous the studies from the literature are in terms of prognosis in both cancers that develop from adenomyosis or those that are only associated with adenomyosis. The pathogenic mechanisms of transformation remain unclear. As these types of cancer are so rare, there is no standardised treatment. A novel target in the diagnosis and treatment of gynaecological malignancies associated with adenomyosis is also being studied for the development of new therapeutic concepts.
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Affiliation(s)
- Liviu Moraru
- Department of Anatomy, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Melinda-Ildiko Mitranovici
- Department of Obstetrics and Gynecology, Emergency County Hospital Hunedoara, 14 Victoriei Street, 331057 Hunedoara, Romania
| | - Diana Maria Chiorean
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
| | - Raluca Moraru
- Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Laura Caravia
- Division of Cellular and Molecular Biology and Histology, Department of Morphological Sciences, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Andreea Taisia Tiron
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ovidiu Simion Cotoi
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
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11
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Wang J, Wang Q, Wang W, Yang J, Xia J, Wei Y. Endometrioid adenocarcinoma arising in adenomyosis in a patient with pelvic organ prolapse-case report. BMC Womens Health 2023; 23:150. [PMID: 36997927 PMCID: PMC10064737 DOI: 10.1186/s12905-023-02310-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Adenomyosis is a frequent finding in endometrial carcinoma patients. Endometrioid adenocarcinoma is the most common type of endometrial carcinoma; however, endometrioid adenocarcinoma arising from adenomyosis is extremely rare. CASE PRESENTATION In this case report, we describe a 69-year-old woman who required surgical treatment for pelvic organ prolapse (POP). The patient had been postmenopausal for 20 years and had no abnormal bleeding after menopause. The patient underwent transvaginal hysterectomy, repair of anterior and posterior vaginal walls, ischium fascial fixation and repair of an old perineal laceration. Histological examination of surgical specimens revealed endometrioid adenocarcinoma of the uterus. Bilateral adnexectomy, pelvic lymphadenectomy and para-aortic lymphadenectomy were then performed. The postoperative histopathological diagnosis was stage IB endometrial cancer (endometrioid carcinoma G2). CONCLUSIONS In summary, endometrioid adenocarcinoma arising from adenomyosis (EC-AIA) is a rare entity and the early diagnosis is difficult. Adequate preoperative assessment and enhanced inquiry of occult clinical symptoms of postmenopausal women before hysterectomy may contribute to the diagnosis of EC-AIA preoperatively.
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Affiliation(s)
- Jing Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qingyuan Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wenyan Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Jian Yang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jingxian Xia
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanan Wei
- Department of Obstetrics and Gynecology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, Anhui, China
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12
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Endometrial Cancer Arising in Adenomyosis (EC-AIA): A Systematic Review. Cancers (Basel) 2023; 15:cancers15041142. [PMID: 36831484 PMCID: PMC9953860 DOI: 10.3390/cancers15041142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/12/2023] Open
Abstract
Endometrial cancer arising in adenomyosis (EC-AIA) is a rare uterine disease characterized by the malignant transformation of the ectopic endometrium within the adenomyotic foci. Clinicopathological and survival data are mostly limited to case reports and a few cohort studies. We aimed to assess the clinicopathological features and survival outcomes of women with EC-AIA through a systematic review of the literature. Six electronic databases were searched, from 2002 to 2022, for all peer-reviewed studies that reported EC-AIA cases. Thirty-seven EC-AIA patients from 27 case reports and four case series were included in our study. In our analysis, EC-AIA appeared as a rare disease that mainly occurs in menopausal women, shares symptoms with endometrial cancer, and is challenging to diagnose preoperatively. Differently from EC, it shows a higher prevalence of the non-endometrioid histotype, advanced FIGO stages, and p53-signature, which might be responsible for its worse prognosis. Future studies are necessary, to confirm our findings and further investigate this rare condition.
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Ohira S, Tachibana R, Yasaki S, Tsunemi K, Uchiyama N, Ikeda E, Sano K. Mucinous carcinoma originating from uterine adenomyosis: a case report. J Med Case Rep 2023; 17:36. [PMID: 36740698 PMCID: PMC9900899 DOI: 10.1186/s13256-023-03772-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 01/12/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Uterine adenomyosis is rarely a precursor of malignant tumors, but the most frequent histological subtype is endometrioid carcinoma. We observed a rare case of mucinous carcinoma originating from uterine adenomyosis. CASE PRESENTATION A 63-year-old Japanese woman presented to our hospital with lower abdominal pain. She had no atypical genital bleeding. Ultrasound demonstrated thickening of the entire uterine wall, but the endometrium was not thick. Magnetic resonance imaging demonstrated an enlarged uterus with thickening of the entire uterine wall, suggesting adenomyosis. On the basis of the specimen of endocervical curettage, adenocarcinoma originating from the endometrium was suspected. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed to confirm the diagnosis. Macroscopically, the resected enlarged uterus had no nodules and exudation of mucin was observed from the cut surface of the thickened myometrium. The surface of the endometrium was smooth. On histological examination, mucinous carcinoma invaded almost the entire myometrium. Adenomyotic lesions were distributed focally in the uterine wall, and transition from adenomyotic glandular epithelium to mucinous carcinoma was detected within several foci. Although adenocarcinoma cells proliferated adjacent to the endometrium, the primary endometrial epithelium was atrophic without atypia. Throughout the myometrium, the mucinous carcinoma cells proliferated and floated in dilated lymph vessels with abundant mucin pools. We diagnosed this case as mucinous carcinoma originating from adenomyosis. Although the patient received 11 courses of intravenous adjuvant chemotherapy, she died of disease 18 months after the first operation. CONCLUSION As only one case of mucinous carcinoma originating from adenomyosis has been reported to date, this is the second case report of mucinous carcinoma. Moreover, an abnormal manner of proliferation with marked lymphatic permeation of the tumor cells throughout the myometrium was observed.
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Affiliation(s)
- Satoshi Ohira
- Department of Obstetrics and Gynecology, Iida Municipal Hospital, 438 Yawatamachi, Iida, 395-8502 Japan
| | - Ryota Tachibana
- Department of Obstetrics and Gynecology, Iida Municipal Hospital, 438 Yawatamachi, Iida, 395-8502 Japan
| | - Sayaka Yasaki
- Department of Obstetrics and Gynecology, Iida Municipal Hospital, 438 Yawatamachi, Iida, 395-8502 Japan
| | - Koji Tsunemi
- Department of Obstetrics and Gynecology, Iida Municipal Hospital, 438 Yawatamachi, Iida, 395-8502 Japan
| | - Natsuki Uchiyama
- Department of Obstetrics and Gynecology, Iida Municipal Hospital, 438 Yawatamachi, Iida, 395-8502 Japan
| | - Eri Ikeda
- Department of Obstetrics and Gynecology, Iida Municipal Hospital, 438 Yawatamachi, Iida, 395-8502 Japan
| | - Kenji Sano
- Department of Pathology, Iida Municipal Hospital, 438 Yawatamachi, Iida, 395-8502 Japan
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14
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Yetimalar MH, Kilic D, Bezircioglu I, Yigit S. The impact of uterine adenomyosis on the histopathological risk factors and survival in patients with endometrial adenocarcinoma. J OBSTET GYNAECOL 2022; 42:2213-2219. [PMID: 35260040 DOI: 10.1080/01443615.2022.2036959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A retrospective cohort study was performed on patients diagnosed with endometrial adenocarcinoma (EC) during a 9-year period to investigate the impact of co-existing adenomyosis on patients with EC. Group A included women with EC and adenomyosis and Group B EC cases without the presence of adenomyosis. Group A was more likely to have early-stage disease, tumours without deep myometrial invasion, low-grade tumours and tumours with negative lymphovascular space invasion when compared to Group B (p = 0.012, p = 0.004, p < 0.001, p = 0.02). There were no statistically significant difference between Group A and Group B for lymph node metastasis (p = 0.064). There was no significant relation between the adenomyosis and survival outcomes in the multivariant analysis (p = 0.437). As a conclusion, patients with adenomyosis were more likely to accompany good histopathologic prognostic factors. Multivariate analysis showed no significant effect of adenomyosis on recurrence and survival parameters.IMPACT STATEMENTWhat is already known on this subject? Adenomyosis is one of the most common accompanying benign histopathological findings of type 1 endometrial carcinomas (EC). Adenomyosis comprises some characteristics similar to malignant tumours, such as invasion, abnormal tissue growth and angiogenesis. Despite concerns have arisen due to both their high incidence and similar molecular links, the possible relation between EC and adenomyosis is still not well grounded.What the results of this study add? We presented a 9-year period retrospective cohort of a tertiary referring single centre and evaluated the prognostic effect of adenomyosis in patients with EC as well as the survival outcomes of these patients. The co-occurrence of adenomyosis was more likely to accompany early-stage (stages 1-2) disease, low-grade tumours (grades 1-2) and tumours with negative LVSI in patients with EC. However, multivariate and survival analysis showed no significant effect of adenomyosis on recurrence and survival parameters.What the implications are of these findings for clinical practice and/or further research? Based on these findings, we suggest that the presence of adenomyosis should not be considered as a prognostic factor in EC. Our results support the overriding opinion about the prognostic value of co-occurrence of adenomyosis and EC. However, further studies exploring the molecular and genomic markers in these two groups are needed to uncover the exact relation of adenomyosis on the prognosis of EC.
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Affiliation(s)
| | - Derya Kilic
- Department of Obstetrics and Gynecology, Pamukkale University, Denizli, Turkey
| | - Incim Bezircioglu
- Department of Obstetrics and Gynecology, Izmir Economy University Hospital, Izmir, Turkey
| | - Seyran Yigit
- Department of Pathology, Izmir Katip Celebi University Ataturk Teaching and Research Hospital, Izmir, Turkey
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15
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Szubert M, Kozirog E, Wilczynski J. Adenomyosis as a Risk Factor for Myometrial or Endometrial Neoplasms—Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042294. [PMID: 35206475 PMCID: PMC8872164 DOI: 10.3390/ijerph19042294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 11/16/2022]
Abstract
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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16
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Chikumi J, Oishi T, Nakaso T, Sawada M, Kudoh A, Komatsu H, Sato S, Taniguchi F, Harada T. Endometrial Cancer Arising in Adenomyosis That Could Not Be Diagnosed by Endometrial Biopsy: A Case Report. Yonago Acta Med 2022; 65:106-110. [DOI: 10.33160/yam.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/24/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Jun Chikumi
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Tetsuro Oishi
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Takaya Nakaso
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Mayumi Sawada
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Akiko Kudoh
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Hiroaki Komatsu
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Shinya Sato
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
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17
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Mohanty P, Hota A, Mohapatra A, Govardhan T. Endometrial clear cell carcinoma with leiomyoma and adenomyosis in a postmenopausal lady - A case report with review. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_224_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Yoshida H, Asami Y, Kobayashi-Kato M, Tanase Y, Uno M, Ishikawa M, Shiraishi K, Kato T. Genetic features of endometrioid-type endometrial carcinoma arising in uterine adenomyosis. Virchows Arch 2021; 481:117-123. [PMID: 34791535 DOI: 10.1007/s00428-021-03234-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022]
Abstract
This study aimed to clarify the genetic features of endometrioid-type endometrial cancer arising in adenomyosis (EC-AIA) using targeted sequencing and immunohistochemistry (IHC) for both carcinoma and adjacent adenomyosis tissues. We identified three endometrioid-type EC-AIAs in 689 patients with endometrial cancer; two exhibited grade 3 endometrioid carcinoma. IHC revealed retained expression of PMS2, MSH6, ARID1A, and PAX2. Two of them showed diffuse strong p53 expression only in the carcinoma. PTEN expression was lost in carcinoma of only one of these cases. Carcinoma had many gene mutations than adjacent adenomyosis in all cases. KRAS and TP53 mutations were found in two of them. The other patient had mutations in KRAS, PIK3CA, and PPP2R1A. They were classified as two "p53-mutated" and one "non-specific molecular profile." These molecular alterations in endometrioid-type EC-AIA imply similar carcinogenesis to a subset of endometrial endometrioid carcinoma and might be used as targets of liquid biopsy after further validation.
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Affiliation(s)
- Hiroshi Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Yuka Asami
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, 104-0045, Japan.,Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, 142-8666, Japan
| | - Mayumi Kobayashi-Kato
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yasuhito Tanase
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Masaya Uno
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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19
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Talwar A, Behera P, Ahuja A, Sarkar B, Phulware RH. Endometrial Serous Carcinoma Arising From Adenomyosis: A Clinico-Pathological Insight. J Family Reprod Health 2021; 15:125-129. [PMID: 34721602 PMCID: PMC8520663 DOI: 10.18502/jfrh.v15i2.6454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Endometrial cancer (EC) is the most commonly diagnosed malignancy and has the second-highest mortality rate among gynecological cancers. Adenomyosis is well-known for abnormal uterine bleeding and is a widely reported entity; however, an EC arising from the adenomyosis is a rare event; even rarer is the occurrence of serous endometrial carcinoma. Case report: A 60-year post-menopausal female presented with post-menopausal bleeding. Subsequently, she underwent a hysterectomy, which showed atrophic and cystic endometrium with extensive adenomyosis and atypical endometrial glands, which are diffusely P53 positive with intervening negative benign and focally positive dysplastic endometrial glands. A final diagnosis of serous endometrial carcinoma arising from adenomyosis was rendered. In a table format, previously reported serous endometrial carcinoma Arising cases from adenomyosis using PubMed search had been described. Conclusion: Serous endometrial carcinoma arising from adenomyosis (<20 cases reported) and has a slightly more dismal prognosis than those deriving from the endometrial cavity. Hence, this case report highlights the occurrence, rarity, and importance of such an entity.
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Affiliation(s)
- Amrita Talwar
- Department of Pathology, Postgraduate Institute of Medical Sciences, Ram Manohar Lohia Hospital, New Delhi, India
| | - Pushpanjali Behera
- Department of Pathology, Postgraduate Institute of Medical Sciences, Ram Manohar Lohia Hospital, New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, Postgraduate Institute of Medical Sciences, Ram Manohar Lohia Hospital, New Delhi, India
| | - Bani Sarkar
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Sciences, Ram Manohar Lohia Hospital, New Delhi, India
| | - Ravi Hari Phulware
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, India
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20
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Raimondo D, Raffone A, Travaglino A, Maletta M, Casadio P, Ambrosio M, Chiara Aru A, Santoro A, Franco Zannoni G, Insabato L, Mollo A, Zullo F, Seracchioli R. Impact of adenomyosis on the prognosis of patients with endometrial cancer. Int J Gynaecol Obstet 2021; 157:265-270. [PMID: 34228822 PMCID: PMC9292168 DOI: 10.1002/ijgo.13818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/19/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022]
Abstract
Background Despite the high prevalence of adenomyosis in hysterectomy specimens of endometrial carcinoma (EC) patients, the relationship between adenomyosis and EC prognosis appears unclear. Objective To assess the prognostic value of coexistent adenomyosis in patients with EC. Methods A systematic review and meta‐analysis was performed by searching six electronic databases for studies reporting data on prognosis of EC patients with and without coexistent adenomyosis. Studies with patient selection based on prognostic factors were excluded. Pooled univariate hazard ratio (HR) analyses for overall survival (OS) and disease‐free survival (DRF) were performed, using EC patients without adenomyosis as a control group. For DFS, pooled multivariate HR analysis was also evaluable. Results Three studies of 2505 EC patients (553 with and 1952 without adenomyosis) were included. Compared with EC patients without adenomyosis, EC patients with coexistent adenomyosis showed a pooled HR of 0.533 (CI 95%, 0.329–0.864) for OS at univariate analysis; 0.536 (CI 95%, 0.334–0.859) for DFS at univariate analysis; and 0.875 (CI 95%, 0.331–2.315) for DFS at multivariate analysis. Conclusion In EC patients with coexistent adenomyosis, the risk of death is halved compared with EC patients without adenomyosis. However, the independence of this association needs to be verified in future studies. The risk of death is halved in EC patients with coexistent adenomyosis compared with EC patients without adenomyosis, whereas the risk of EC recurrence does not appear to be affected.
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Affiliation(s)
- Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy.,Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Manuela Maletta
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Marco Ambrosio
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Anna Chiara Aru
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Angela Santoro
- Pathology Unit, Department of Woman and Child Health, Agostino Gemelli University Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Gian Franco Zannoni
- Pathology Unit, Department of Woman and Child Health, Agostino Gemelli University Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Insabato
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Mollo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
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21
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Raffone A, Seracchioli R, Raimondo D, Maletta M, Travaglino A, Raimondo I, Giaquinto I, Orsini B, Insabato L, Pellicano M, Zullo F. Prevalence of adenomyosis in endometrial cancer patients: a systematic review and meta-analysis. Arch Gynecol Obstet 2021; 303:47-53. [PMID: 33098006 PMCID: PMC7854401 DOI: 10.1007/s00404-020-05840-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Several studies have assessed the histological co-existence of endometrial carcinoma (EC) and adenomyosis. However, the significance of this association is still unclear. OBJECTIVE To assess the prevalence of adenomyosis in women with EC for a better understanding of the association between the two diseases. MATERIALS AND METHODS A systematic review and meta-analysis was performed by searching electronics databases from their inception to March 2020, for all studies that allowed extraction of data about prevalence of adenomyosis in EC patients. Adenomyosis prevalence was calculated for each included study and as pooled estimate, with 95% confidence interval (CI). RESULTS Eight retrospective cohort studies assessing 5573 EC patients were included in our analysis. Of total, 1322 were patients with adenomyosis, and 4251 were patients without adenomyosis. Pooled prevalence of adenomyosis in EC patients was 22.6% (95% CI 12.7-37.1%). CONCLUSION Adenomyosis prevalence in EC patients was not different from that reported for other gynecological conditions. The supposed association between the two diseases appears unsupported.
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Affiliation(s)
- Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Renato Seracchioli
- Gynecology and Human Reproduction Physiopathology, Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), IRCCS S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Gynecology and Human Reproduction Physiopathology, Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), IRCCS S. Orsola Hospital, University of Bologna, Bologna, Italy.
| | - Manuela Maletta
- Gynecology and Human Reproduction Physiopathology, Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), IRCCS S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Ivano Raimondo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- School in Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Ilaria Giaquinto
- Gynecology and Human Reproduction Physiopathology, Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), IRCCS S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Benedetta Orsini
- Gynecology and Human Reproduction Physiopathology, Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), IRCCS S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Luigi Insabato
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Massimiliano Pellicano
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Samimi G, Sathyamoorthy N, Tingen CM, Mazloomdoost D, Conroy J, Heckman-Stoddard B, Halvorson LM. Report of the National Cancer Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development-sponsored workshop: gynecology and women's health-benign conditions and cancer. Am J Obstet Gynecol 2020; 223:796-808. [PMID: 32835714 DOI: 10.1016/j.ajog.2020.08.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/31/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022]
Abstract
The Division of Cancer Prevention and the Division of Cancer Biology at the National Cancer Institute and the Gynecologic Health and Disease Branch in the National Institute of Child Health and Human Development organized a workshop in April 2019 to explore current insights into the progression of gynecologic cancers from benign conditions. Working groups were formed based on 3 gynecologic disease types: (1) Endometriosis or Endometrial Cancer and Endometrial-Associated Ovarian Cancer, (2) Uterine Fibroids (Leiomyoma) or Leiomyosarcoma, and (3) Adenomyosis or Adenocarcinoma. In this report, we highlight the key questions and current challenges that emerged from the working group discussions and present potential research opportunities that may advance our understanding of the progression of gynecologic benign conditions to cancer.
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23
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An M, Duan H, Zhang Y. Prognostic significance of co‐existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: A meta‐analysis. J Obstet Gynaecol Res 2020; 46:1851-1863. [DOI: 10.1111/jog.14371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/02/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Min An
- Department of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology HospitalCapital Medical University Beijing China
| | - Hua Duan
- Department of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology HospitalCapital Medical University Beijing China
| | - Ying Zhang
- Department of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology HospitalCapital Medical University Beijing China
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Chao X, Wu M, Ma S, Tan X, Zhong S, Bi Y, Wu H, Lang J, Li L. The clinicopathological characteristics and survival outcomes of endometrial carcinoma coexisting with or arising in adenomyosis: A pilot study. Sci Rep 2020; 10:5984. [PMID: 32249826 PMCID: PMC7136226 DOI: 10.1038/s41598-020-63065-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Little is known about the epidemiological and clinicopathological characteristics of endometrial endometrioid carcinoma (EEC) coexisting with or arising in adenomyosis (EEC-A or EEC-AIA) due to their rarity. This study compared EEC-A and EEC-AIA with endometrial carcinoma without adenomyosis. Cases of endometrial cancer treated at the study center from June 1, 2010, to June 1, 2017, were reviewed. The epidemiological, clinicopathological characteristics and survival outcomes were compared among three groups of endometrioid subtypes: group A, stage IA endometrial carcinoma patients without coexisting adenomyosis; group B, patients with EEC-A; and group C, patients with EEC-AIA. Among the 2080 patients reviewed, groups A, B, and C included 1043, 230 and 28 patients, respectively. Patients in group A and group B had similar clinicopathological and survival outcomes. Patients in group C were significantly younger and had less gravidity and parity than patients in groups A and B. More tumors from group C were grade 1, and they had a smaller maximum diameter and less mismatch repair deficiency than those from groups A and B. After a median follow-up of 57.0 months, the 5-year disease-free survival (DFS) rates of groups A, B and C were 96%, 91% and 100% (p = 0.045), respectively; the 5-year overall survival (OS) rates were 98%, 93% and 100%, respectively (p = 0.001), in the Kaplan-Meier analysis. However, these difference disappeared in a subgroup of stage IA patients in univariate and multivariate analysis. Cox regression analysis in stage IA patients also revealed no significant differences in survival outcome across the three groups. In conclusion, EEC-AIA exhibited specific clinicopathological characteristics that were probably associated with favorable survival outcomes. The characteristics and survival outcomes of EEC-A were similar to those of EEC without adenomyosis in stage IA patients.
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Affiliation(s)
- Xiaopei Chao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Shuiqing Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xianjie Tan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Sen Zhong
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yalan Bi
- Department of Pathology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Huanwen Wu
- Department of Pathology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, 100730, China.
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Izumi Y, Yamamoto T, Matsunaga N, Ota T, Owaki Y, Shinohara K, Tsuzuki T, Suzuki K. Endometrial cancer arising from adenomyosis: Case report and literature review of MRI findings. Radiol Case Rep 2020; 15:427-430. [PMID: 32099587 PMCID: PMC7031131 DOI: 10.1016/j.radcr.2020.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Abstract
Endometrial cancer arising from adenomyosis (EC-AIA) is extremely rare, and the typical magnetic resonance imaging (MRI) findings of EC-AIA have not been established. We report a case of EC-AIA that was detected preoperatively on MRI and conduct a literature review of the MRI findings of EC-AIA.
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Affiliation(s)
- Yuichiro Izumi
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute 480-1195, Japan
- Corresponding author.
| | - Takahiro Yamamoto
- Department of Radiology, The Aichi Prefectural Federation of Agricultural Cooperatives for Health and Welfare Kainan Hospital, 396 Minamihonden, Maegasu-cho, Yatomi 498-8502, Japan
| | - Nozomu Matsunaga
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute 480-1195, Japan
| | - Toyohiro Ota
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute 480-1195, Japan
| | - Yuki Owaki
- Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine, 1-1 YazakoKarimata, Nagakute 480-1195, Japan
| | - Koichi Shinohara
- Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine, 1-1 YazakoKarimata, Nagakute 480-1195, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute 480-1195, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute 480-1195, Japan
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26
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Boonlak S, Aue-Aungkul A, Kietpeerakool C, Kleebkaow P, Chumworathayi B, Luanratanakorn S, Temtanakitpaisan A. Impact of Coexisting Uterine Adenomyosis on the Survival
Outcome of Patients with Endometrial Cancer: A Retrospective
Cohort Study. Asian Pac J Cancer Prev 2019; 20:1185-1190. [PMID: 31030493 PMCID: PMC6948917 DOI: 10.31557/apjcp.2019.20.4.1185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: To determine the effects of uterine adenomyosis on endometrial cancerrecurrence rates. Methods: This retrospective cohort study reviewed all consecutive patients diagnosed with endometrial cancerwho underwent total hysterectomy-based surgical staging at Srinagarind Hospital between January, 2010 and January, 2016. The patientswere divided into two groups:a uterine adenomyosisgroup and a non-adenomyosis group. Patient demographics, type of surgery, histopathology, stage of endometrial cancer, adjuvant treatment, and survival outcomes were compared. Results: A total 350 patients were enrolled, with 132 (37.71%) in the adenomyosis group and 218 (62.29%) in the non-adenomyosis group. Deep myometrial invasion and lymphovascular space invasion (LVSI) were more commonly found among patients who had no adenomyosis compared to those with adenomyosis(52.8% vs 39.4%, P=0.02 and 53.2% vs. 38.6%, P=0.01). There were no significant differences in terms of five-year recurrence-free survival (HR=1.47; 95%CI 0.88-2.44) and five-year overall survival (HR=0.81; 95%CI 0.43-1.53) between the two comparison groups. Conclusion: Coexisting uterine adenomyosis in endometrial cancer wasassociated withdeep myometrial invasion and LVSI but did not have significant impact on survival.
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Affiliation(s)
- Sarana Boonlak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Apiwat Aue-Aungkul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Chumnan Kietpeerakool
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Pilaiwan Kleebkaow
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Bandit Chumworathayi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Thailand.
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27
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Liu CH, Chang WH, Liu WM, Wang PH. Serous carcinoma arising from adenomyosis. Taiwan J Obstet Gynecol 2018; 56:706-707. [PMID: 29037565 DOI: 10.1016/j.tjog.2017.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Hsun Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Min Liu
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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Impact of coexistent adenomyosis on outcomes of patients with endometrioid endometrial cancer: a propensity score-matched analysis. TUMORI JOURNAL 2018; 104:60-65. [PMID: 29192745 DOI: 10.5301/tj.5000698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Despite the common occurrence of adenomyosis in endometrial cancer (EC), there is a paucity and conflict in the literature regarding its impact on outcomes of patients. We sought to compare outcomes of patients with endometrioid type EC with or without adenomyosis. METHODS A total of 314 patients were included in the analysis. Patients were divided into 2 groups according to the presence or absence of adenomyosis. Adenomyosis was identified in 79 patients (25.1%). A propensity score-matched comparison (1:1) was carried out to minimize selection biases. The propensity score was developed through multivariable logistic regression model including age, stage, and tumor grade as covariates. After performing propensity score matching, 70 patients from each group were successfully matched. Primary outcome of the study was disease-free survival (DFS), and the secondary outcomes were overall survival (OS) and disease-specific survival (DSS). RESULTS Median follow-up time was 61 months for the adenomyosis positive group and 76 months for the adenomyosis negative group. There were no statistically significant differences in 3- and 5-year DFS, OS, and DSS rates between the 2 groups. Five-year DFS was 92% vs 88% (hazard ratio [HR] 1.54 [0.56-4.27]; p = 0.404), 5-year OS was 94% vs 92% (HR 1.60 [0.49-5.26]; p = 0.441), and 5-year DSS was 94% vs 96% (HR 2.51 [0.46-13.71]; p = 0.290) for patients with and without adenomyosis, respectively. CONCLUSIONS Coexistent adenomyosis in EC is not a prognostic factor and does not impact survival outcomes.
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Yeh CC, Su FH, Tzeng CR, Muo CH, Wang WC. Women with adenomyosis are at higher risks of endometrial and thyroid cancers: A population-based historical cohort study. PLoS One 2018. [PMID: 29522577 PMCID: PMC5844548 DOI: 10.1371/journal.pone.0194011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective Both adenomyosis and endometriosis are characterized by the presence of ectopic endometrial glands and stroma and have been suggested to share some characteristics with malignant tumors. Although accumulating evidence indicates that endometriosis is associated with some cancer types, the cancer risks in patients with adenomyosis have been rarely examined. In this study, we investigated the relationship between adenomyosis and risks of common cancers. Methods This study included a cohort of 12,447 women with adenomyosis but not endometriosis, born in 1951–1984, and a cohort of 124,470 adenomyosis-free women matched by birth year. Their medical records (collected between 1996 and 2011) were obtained from the National Health Insurance Research Database of Taiwan. We first compared the distribution of cancer-free survival (CFS) between cohorts with and without adenomyosis. Subsequently, within the adenomyosis cohort, we examined whether time-to-onset of the identified cancer type was correlated with time-to-onset of adenomyosis. The Cox proportional hazards model was used to compare the distribution of CFS between the adenomyosis and adenomyosis-free cohorts and between the early- and late-diagnosed adenomyosis groups. For comparison, we further evaluated the cancer risks for a cohort of 10,962 women with endometriosis but not adenomyosis and a birth-year matched cohort of 109,620 endometriosis-free women. Results Compared with adenomyosis-free women, patients with adenomyosis had higher risks of endometrial and thyroid cancers, with estimated hazard ratios (HRs) (95% confidence interval) of 2.19 (1.51–3.16) and 1.70 (1.29–2.24), respectively. For both cancers, distributions of CFS were not significantly different between the early- and late-diagnosed adenomyosis groups. Furthermore, compared with endometriosis-free women, patients with endometriosis had higher risks of endometrial and ovarian cancers, with HRs of 1.89 (1.07–3.35) and 2.01 (1.27–3.16), respectively. Conclusions Women with adenomyosis are at higher risks of endometrial and thyroid cancers, while women with endometriosis are at higher risks of endometrial and ovarian cancers.
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Affiliation(s)
- Chih-Ching Yeh
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Fu-Hsiung Su
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Division of Family Medicine, Department of Community Medicine and Long Term Care, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Chii-Ruey Tzeng
- Center for Reproductive Medicine and Sciences, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Hsin Muo
- College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Chang Wang
- The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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