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Ruaux E, Nougaret S, Gavrel M, Charlot M, Devouassoux-Shisheboran M, Golfier F, Thomassin-Naggara I, Rousset P. Endometriosis MR mimickers: T1-hyperintense lesions. Insights Imaging 2024; 15:19. [PMID: 38267748 PMCID: PMC10808095 DOI: 10.1186/s13244-023-01587-3] [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: 06/27/2023] [Accepted: 11/25/2023] [Indexed: 01/26/2024] Open
Abstract
Endometriosis is a chronic and disabling gynecological disease that affects women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While MRI offers higher sensitivity compared to ultrasonography, it is prone to false-positive results, leading to decreased specificity. False-positive findings can arise from various T1-hyperintense conditions on fat-suppressed T1-weighted images, resembling endometriotic cystic lesions in different anatomical compartments. These conditions include hemorrhage, hyperproteic content, MRI artifacts, feces, or melanin. Such false positives can have significant implications for patient care, ranging from incorrect diagnoses to unnecessary medical or surgical interventions and subsequent follow-up. To address these challenges, this educational review aims to provide radiologists with comprehensive knowledge about MRI criteria, potential pitfalls, and differential diagnoses, ultimately reducing false-positive results related to T1-hyperintense abnormalities.Critical relevance statementMRI has a 10% false-positive rate, leading to misdiagnosis. T1-hyperintense lesions, observed in the three phenotypes of pelvic endometriosis, can also be seen in various other causes, mainly caused by hemorrhages, high protein concentrations, and artifacts.Key points• MRI in endometriosis has a 10% false-positive rate, leading to potential misdiagnosis.• Pelvic endometriosis lesions can exhibit T1-hyperintensity across their three phenotypes.• A definitive diagnosis of a T1-hyperintense endometriotic lesion is crucial for patient management.• Hemorrhages, high protein concentrations, lipids, and artifacts are the main sources of T1-hyperintense mimickers.
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Affiliation(s)
- Edouard Ruaux
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, 165 Chemin du Grand Revoyet, EMR 3738, 69495, Pierre Bénite, France
| | - Stéphanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, U1194, Montpellier University, 34295, Montpellier, France
| | - Marie Gavrel
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Mathilde Charlot
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, 69495, Pierre Bénite, France
| | - François Golfier
- Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, 69495, Pierre Bénite, France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Service Imageries Radiologiques et Interventionnelles Spécialisées, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 75020, Paris, France
| | - Pascal Rousset
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, 165 Chemin du Grand Revoyet, EMR 3738, 69495, Pierre Bénite, France.
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Abstract
Endometriosis will affect about 10% of the female population and not only can it significantly impact adversely on quality of life and result in infertility, but data are accumulating that malignant transformation is an important consideration. Endometriosis can be histologically typical or atypical, ovarian, superficial peritoneal or deep infiltrating. The precursor for malignant transformation appears to be the ovarian atypical endometriosis component. Ovarian cancer is the most important associated cancer, primarily endometrioid and clear cell cancer. These are the only subtypes wherein a direct clonal relationship between endometriosis, as a direct precursor, and cancer has been made. There is no substantive evidence to support an altered association of borderline cancers of the ovary, serous ovarian cancers and breast, endometrial or cervical cancers. This review provides an overview of the prevailing data pertaining to the molecular and genetic aberrations that accompany the transformation of atypical endometriosis to malignancy and the accumulated epidemiologic evidence which supports the association.
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Affiliation(s)
- F Guidozzi
- Parklane Clinic, Johannesburg, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
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Fallopian tube endometriosis in women undergoing operative video laparoscopy and its clinical implications. Fertil Steril 2020; 114:1040-1048. [PMID: 32826047 DOI: 10.1016/j.fertnstert.2020.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the incidence of fallopian tube endometriosis in patients undergoing laparoscopic surgery with a preoperative diagnosis of endometriosis, pelvic pain, infertility, or cystic adnexal mass. DESIGN Retrospective cross-sectional study. SETTING Gynecologic oncology and minimally invasive surgery practice. PATIENT(S) All patients who underwent surgery for endometriosis from July 2015 to June 2018 were included. Exclusion criteria were age ≥55 years, diagnosis of cancer, laparotomy, previous bilateral salpingectomy, and preoperative diagnosis other than endometriosis, pelvic pain, infertility, or cystic adnexal mass. INTERVENTION(S) Subjects were divided by those who did and those who did not have a salpingectomy at the time of surgery. MAIN OUTCOME MEASURE(S) Diagnosis of tubal endometriosis was based on macroscopic evidence of endometrial implants on the fallopian tube(s) noted within the operative report and microscopic evidence of endometriosis noted within the pathology report. RESULT(S) A total of 444 surgeries were performed and 185 met the study criteria. Among those, 153 (82.7%) had histologically diagnosed endometriosis within the abdominopelvic cavity. The incidence of tubal endometriosis was 11%-12% macroscopically and 42.5% microscopically after salpingectomy. Patients with tubal endometriosis were more likely to have severe disease. CONCLUSION(S) Among patients with endometriosis, the incidence of microscopic tubal endometriosis was significantly greater than that of macroscopic disease.
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Pejovic T, Thisted S, White M, Nezhat FR. Endometriosis and Endometriosis-Associated Ovarian Cancer (EAOC). ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1242:73-87. [DOI: 10.1007/978-3-030-38474-6_5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Nezhat C, Vu M, Vang N, Ganjoo K, Karam A, Folkins A, Nezhat A, Nezhat F. Endometriosis Malignant Transformation Review: Rhabdomyosarcoma Arising From an Endometrioma. JSLS 2019; 23:JSLS.2019.00038. [PMID: 31624455 PMCID: PMC6791399 DOI: 10.4293/jsls.2019.00038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Endometriosis is a widely known benign disease, but 0.5%–1% of cases are associated with malignancy. It has been linked with ovarian neoplasms, particularly endometrioid and clear cell adenocarcinoma histology. Rhabdomyosarcomas are rarely associated with endometriosis. Case: A 35-year-old patient underwent surgical management of endometriomas to optimize infertility treatment. She later developed abdominal pain with rapid recurrence of ovarian masses. This prompted additional surgery with biopsies diagnosing ovarian rhabdomyosarcoma. Retroactive review of pathologic specimens from her prior surgery demonstrated the neoplasm originated from her prior endometrioma. Focal areas suggested possible underlying ovarian adenosarcoma with stromal overgrowth. Discussion: The incidence of rhabdomyosarcoma arising from endometriosis is exceedingly rare. The accuracy of diagnosing endometriosis and ruling out neoplasm requires coordinated efforts of a multidisciplinary team, involving radiologists, pathologists, oncologists, and gynecologic surgeons.
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Affiliation(s)
- Camran Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Mailinh Vu
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Nataliya Vang
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Kristen Ganjoo
- Stanford Comprehensive Cancer Center, Stanford University Medical Center, Stanford, California, USA
| | - Amer Karam
- Stanford Women's Cancer Center, Stanford University Medical Center, Stanford, California, USA
| | - Ann Folkins
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Azadeh Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Farr Nezhat
- Nezhat Surgery for Gynecology/Oncology, Weill Cornell Medical College of Cornell University, New York City, New York, USA
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Taniguchi F. New knowledge and insights about the malignant transformation of endometriosis. J Obstet Gynaecol Res 2018; 43:1093-1100. [PMID: 28718209 DOI: 10.1111/jog.13372] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/13/2017] [Accepted: 04/02/2017] [Indexed: 12/25/2022]
Abstract
Endometriosis may be a definitive risk factor for ovarian cancer, the most fatal gynecological cancer. The ability of endometriosis to transform into malignancy, first described by Dr. Sampson in 1925, is considered a rare occurrence, affecting approximately 1% of ovarian endometriomas. Recently we conducted a retrospective study regarding the malignant transformation of endometriosis in Japanese women. Many studies have reported a consistent correlation between endometriosis and ovarian cancer according to histological subtypes. However, the existing epidemiological evidence linking this association is insufficient to define the role of endometriosis as a cause of ovarian cancer and to influence changes to current clinical practice. Prospective cohort studies are therefore needed to clarify this issue. Additionally, the results of many molecular studies are conflicting, and earlier studies showing the molecular aberrations involved in genomic instability and mutation that enable malignant transformation have not been replicated in later studies. Careful long-term observation of a patient with endometrioma is required to detect possible subsequent incidence of malignant transformation. More importantly, a precise strategy should be set up for better prevention, early detection, specific diagnosis and treatment targeting molecular pathogenesis to understand the mechanisms of endometriosis-associated ovarian cancer. Clinicians need to be aware of the increased ovarian cancer risk in women with endometriosis.
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Affiliation(s)
- Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan
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Improved clinical outcomes of patients with ovarian carcinoma arising in endometriosis. Oncotarget 2018; 8:5843-5852. [PMID: 27992377 PMCID: PMC5351594 DOI: 10.18632/oncotarget.13967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 12/12/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite enormous efforts to dissect the role of endometriosis in ovarian cancer development, the difference in prognosis between ovarian cancer patients with or without endometriosis remains elusive. The purpose of this study is to assess the association between endometriosis and the prognosis in patients with ovarian cancer. RESULTS Ovarian cancer arising in endometriosis tended to be presented as clear cell histology, early stage, less intraperitoneal metastasis and ascites, and lower CA125 level compared with those without endometriosis. Multivariate Cox regression analysis identified endometriosis as an independent prognostic factor for progression free survival (P = 0.002) and overall survival (P = 0.009) in all patients and especially for early stage. A nomogram integrating endometriosis, FIGO stage and CA125 was established to predict progression free survival and overall survival. MATERIALS AND METHODS This study retrospectively enrolled 196 ovarian cancers arising or not in endometriosis judged by adjunctive use of CD10 immunohistochemistry in conjunction with H&E staining specimens. Clinicopathologic variables, progression-free survival (PFS) and overall survival (OS) were recorded. Kaplan-Meier analysis was performed to compare survival curves. Cox regression models were used to analyze the effect of endometriosis on PFS and OS. A prognostic nomogram was constructed based on the independent prognostic factors identified by multivariate analysis. CONCLUSIONS Endometriosis is an independent predictor of prognosis in ovarian cancer patients.
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Nezhat FR, Apostol R, Nezhat C, Pejovic T. New insights in the pathophysiology of ovarian cancer and implications for screening and prevention. Am J Obstet Gynecol 2015; 213:262-7. [PMID: 25818671 DOI: 10.1016/j.ajog.2015.03.044] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/31/2015] [Accepted: 03/20/2015] [Indexed: 11/30/2022]
Abstract
Despite advances in medicine, ovarian cancer remains the deadliest of the gynecological malignancies. Herein we present the latest information on the pathophysiology of ovarian cancer and its significance for ovarian cancer screening and prevention. A new paradigm for ovarian cancer pathogenesis presupposes 2 distinct types of ovarian epithelial carcinoma with distinct molecular profiles: type I and type II carcinomas. Type I tumors include endometrioid, clear-cell carcinoma, and low-grade serous carcinoma and mostly arise via defined sequence either from endometriosis or from borderline serous tumors, mostly presenting in an early stage. More frequent type II carcinomas are usually high-grade serous tumors, and recent evidence suggests that the majority arise from the fimbriated end of the fallopian tube. Subsequently, high-grade serous carcinomas usually present at advanced stages, likely as a consequence of the rapid peritoneal seeding from the open ends of the fallopian tubes. On the other hand, careful clinical evaluation should be performed along with risk stratification and targeted treatment of women with premalignant conditions leading to type I cancers, most notably endometriosis and endometriomas. Although the chance of malignant transformation is low, an understanding of this link offers a possibility of prevention and early intervention. This new evidence explains difficulties in ovarian cancer screening and helps in forming new recommendations for ovarian cancer risk evaluation and prophylactic treatments.
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MESH Headings
- Adenocarcinoma, Clear Cell/classification
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/prevention & control
- Carcinoma, Endometrioid/classification
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/prevention & control
- Early Detection of Cancer
- Endometriosis/surgery
- Fallopian Tubes
- Female
- Humans
- Neoplasm Grading
- Neoplasms, Cystic, Mucinous, and Serous/classification
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/prevention & control
- Ovarian Diseases/surgery
- Ovarian Neoplasms/classification
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/prevention & control
- Ovariectomy
- Precancerous Conditions/surgery
- Salpingectomy
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Affiliation(s)
- Farr R Nezhat
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mount Sinai Roosevelt, Division of Minimally Invasive Gynecologic Surgery, Winthrop University Hospital, State University of New York at Stony Brook, College of Medicine, New York, NY.
| | - Radu Apostol
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Mount Sinai-St. Luke's and Roosevelt Hospital System, New York, NY
| | - Camran Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA
| | - Tanja Pejovic
- Division of Gynecologic Oncology, Oregon Health and Science University, Portland, OR
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Guo SW. Endometriosis and ovarian cancer: potential benefits and harms of screening and risk-reducing surgery. Fertil Steril 2015; 104:813-830. [PMID: 26335131 DOI: 10.1016/j.fertnstert.2015.08.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 12/23/2022]
Abstract
Although endometriosis is well recognized as a benign gynecologic condition, its association with ovarian cancer (OVCA) has frequently been reported. Review articles on this topic are voluminous, yet there seems to be no consensus as to whether endometriosis is truly a precursor of OVCA and whether any screening or risk-reducing surgery should be instituted, on the basis of our current knowledge. In this review, published data are compiled and critically appraised. Through this critical appraisal, it seems clear that the strongest evidence seems to come from prevalence data. This type of data also suggests a reduced risk of certain histotypes (mainly type II) of OVCA in women with endometriosis. This may explain the rather moderate increase in risk as shown in epidemiologic studies. Even with this moderate increase in OVCA risk, caution should be exercised because of apparent bias in favor of publication of positive results, extensive heterogeneities among prevalence estimates, and inverse relationship between estimates and sizes of the studies. Many molecular studies are conflicting, and earlier studies showing molecular aberrations involved in genomic instability and mutation that enable malignant transformation are not replicated in later studies. Given the low incidence of OVCA and the rather moderate increase in risk of mostly type I tumors, screening seems to be ill-advised, and risk-reducing surgery such as salpingectomy with or without oophorectomy does not seem to yield any substantial benefit to women with endometriosis.
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Affiliation(s)
- Sun-Wei Guo
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, People's Republic of China; Department of Biochemistry and Molecular Biology, Shanghai College of Medicine, Fudan University, Shanghai, People's Republic of China.
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Jaiman S, Pochiraju M, Gundabattula SR, Surampudi K, Narayana Rao DVL, Kandikattu S. Malignant Transformation of Pelvic Endometriosis: Case Series and Review of the Literature. Int J Surg Pathol 2015; 23:465-71. [PMID: 25911569 DOI: 10.1177/1066896915583995] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endometriosis affects 4% to 13% of all women of reproductive age although its true incidence is unknown. The ability of endometriosis to transform into malignancy, first described by Sampson in 1925, is a rare occurrence affecting 1% of lesions with ovary being the primary site in 79%. The authors describe 3 premenopausal women without risk factors for malignancy presenting with ovarian and/or extraovarian endometrioid adenocarcinoma. All of them demonstrated features of pre-/coexisting endometriosis but malignancy was preoperatively suspected in only 1 instance. Postsurgical follow-up of the cases did not document any recurrence. The propensity for malignant conversion occurring in women 10 to 20 years younger vis-a-vis those affected by de novo ovarian cancer, destruction of the endometriotic foci, and underreporting vindicate close follow-up and scrutiny of women with endometriosis and ovarian endometriomas.
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Ye S, Yang J, You Y, Cao D, Bai H, Lang J, Chen J, Shen K. Comparative study of ovarian clear cell carcinoma with and without endometriosis in People's Republic of China. Fertil Steril 2014; 102:1656-62. [DOI: 10.1016/j.fertnstert.2014.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/30/2014] [Accepted: 08/04/2014] [Indexed: 12/23/2022]
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Nezhat FR, Pejovic T, Finger TN, Khalil SS. Role of minimally invasive surgery in ovarian cancer. J Minim Invasive Gynecol 2014; 20:754-65. [PMID: 24183269 DOI: 10.1016/j.jmig.2013.04.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 12/18/2022]
Abstract
The standard treatment of ovarian cancer includes upfront surgery with intent to accurately diagnose and stage the disease and to perform maximal cytoreduction, followed by chemotherapy in most cases. Surgical staging of ovarian cancer traditionally has included exploratory laparotomy with peritoneal washings, hysterectomy, salpingo-oophorectomy, omentectomy, multiple peritoneal biopsies, and possible pelvic and para-aortic lymphadenectomy. In the early 1990s, pioneers in laparoscopic surgery used minimally invasive techniques to treat gynecologic cancers, including laparoscopic staging of early ovarian cancer and primary and secondary cytoreduction in advanced and recurrent disease in selected cases. Since then, the role of minimally invasive surgery in gynecologic oncology has been continually expanding, and today advanced laparoscopic and robotic-assisted laparoscopic techniques are used to evaluate and treat cervical and endometrial cancer. However, the important question about the place of the minimally invasive approach in surgical treatment of ovarian cancer remains to be evaluated and answered. Overall, the potential role of minimally invasive surgery in treatment of ovarian cancer is as follows: i) laparoscopic evaluation, diagnosis, and staging of apparent early ovarian cancer; ii) laparoscopic assessment of feasibility of upfront surgical cytoreduction to no visible disease; iii) laparoscopic debulking of advanced ovarian cancer; iv) laparoscopic reassessment in patients with complete remission after primary treatment; and v) laparoscopic assessment and cytoreduction of recurrent disease. The accurate diagnosis of suspect adnexal masses, the safety and feasibility of this surgical approach in early ovarian cancer, the promise of laparoscopy as the most accurate tool for triaging patients with advanced disease for surgery vs upfront chemotherapy or neoadjuvant chemotherapy, and its potential in treatment of advanced cancer have been documented and therefore should be incorporated in the surgical methods of every gynecologic oncology unit and in the training programs in gynecologic oncology.
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Affiliation(s)
- Farr R Nezhat
- Divisions of Gynecologic Oncology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, St. Luke's and Roosevelt Hospitals, New York, New York.
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Matsushita H, Watanabe K, Yokoi T, Wakatsuki A. Unexpected ovarian malignancy following laparoscopic excision of adnexal masses. Hum Reprod 2014; 29:1912-7. [PMID: 24964925 DOI: 10.1093/humrep/deu162] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
STUDY QUESTION What are the frequency of, and the prognosis for, ovarian malignancies among patients who have undergone laparoscopic surgery for an adnexal mass? SUMMARY ANSWER The rate of unexpected ovarian malignancy resected by laparoscopy was 1.5%, and the presence of an early-stage unexpected ovarian malignancy did not alter patient prognosis. WHAT IS KNOWN ALREADY Even when laparoscopic surgery is used for the resection of an adnexal mass that is most likely benign, some patients are found to have malignant tumors post-operatively. STUDY DESIGN, SIZE, DURATION The pathologic reports of 884 women who underwent laparoscopic resection of an adnexal mass between May 2007 and September 2013 at the Department of Obstetrics and Gynecology of Aichi Medical University Hospital, Nagakute, Japan, were reviewed retrospectively. PARTICIPANTS/MATERIALS, SETTING, METHODS We conducted a systematic review of the medical records of patients diagnosed post-operatively with ovarian malignancies and abstracted their demographic, clinical and pathologic data. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1128 adnexal masses were resected, and 13 patients (1.5%) had ovarian malignancies: 6 ovarian cancer (1 mucinous, 1 endometrioid G1, 1 granulosa cell and 3 carcinoid) and 7 borderline tumors (BOTs; 5 mucinous and 2 serous). Of these, two patients with mucinous BOTs underwent fertility-sparing surgery and six patients underwent staging laparotomy. Due to cyst rupture during surgery, nine patients (69.2%) were upgraded to tumor stage IC. Secondary surgeries were performed in eight patients, with a mean interval of 88.9 days (range, 39-182 days) between the surgeries. All patients were alive and without evidence of disease at follow-up (mean follow-up, 38 months; range, 6-80 months). LIMITATIONS, REASONS FOR CAUTION This was a retrospective study with a small case number and a short follow-up period. WIDER IMPLICATIONS OF THE FINDINGS The presence of an early-stage unexpected ovarian malignancy did not alter the patient's prognosis, even if there was a significant delay in surgical staging after the finding of an unexpected malignancy during laparoscopy. STUDY FUNDING/COMPETING INTERESTS No funding was obtained for this study and the authors report no conflicts of interest.
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Affiliation(s)
- H Matsushita
- Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - K Watanabe
- Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - T Yokoi
- Department of Diagnostic Pathology, Aichi Medical University School of Medicine, Nagakute, Aichi 480-1195, Japan
| | - A Wakatsuki
- Department of Obstetrics and Gynecology, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
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Nezhat F, Apostol R, Mahmoud M, el Daouk M. Malignant transformation of endometriosis and its clinical significance. Fertil Steril 2014; 102:342-4. [PMID: 24880652 DOI: 10.1016/j.fertnstert.2014.04.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/17/2014] [Accepted: 04/30/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Farr Nezhat
- Divisions of Gynecologic Oncology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital, Member of Mount Sinai, Icahn School of Medicine, New York, New York
| | - Radu Apostol
- Divisions of Gynecologic Oncology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital, Member of Mount Sinai, Icahn School of Medicine, New York, New York
| | - Mohamad Mahmoud
- Divisions of Gynecologic Oncology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital, Member of Mount Sinai, Icahn School of Medicine, New York, New York
| | - Manal el Daouk
- Divisions of Gynecologic Oncology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital, Member of Mount Sinai, Icahn School of Medicine, New York, New York
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Abstract
ObjectivesThe objectives of this study were to evaluate the current evidence of the association of endometriosis and subsequent carcinoma of the ovary and to contextualize this evidence into daily practice issues.MethodsThis study is a critical review of observational and in vitro studies.ResultsAlthough the lifetime risk for ovarian cancer is low in general population and remains low in the broad spectrum of endometriosis, there may be clusters of individuals at higher risk of oncogenesis, whose identification would allow individualized surveillance and prophylactic interventions. Prevalence studies show that specific subtypes of ovarian cancer predominate in women with endometriosis. This has been validated in pathogenetic, genomic, immunobiologic, and hormonal studies.ConclusionsTaken together, these data provide a strong rationale for identifying, monitoring, counseling, and treating women with endometriosis who are at highest risk for cancer conversion.
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Taniguchi F, Harada T, Kobayashi H, Hayashi K, Momoeda M, Terakawa N. Clinical Characteristics of Patients in Japan with Ovarian Cancer Presumably Arising from Ovarian Endometrioma. Gynecol Obstet Invest 2014; 77:104-10. [DOI: 10.1159/000357819] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 11/18/2013] [Indexed: 11/19/2022]
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Gottheil S, McGee J. Endometrioid Ovarian Carcinoma During Pregnancy Presenting With Acute Rupture. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:1020-1022. [DOI: 10.1016/s1701-2163(15)30790-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Heidemann LN, Hartwell D, Heidemann CH, Jochumsen KM. The relation between endometriosis and ovarian cancer - a review. Acta Obstet Gynecol Scand 2013; 93:20-31. [PMID: 24011403 DOI: 10.1111/aogs.12255] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 08/30/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endometriosis is known to harbor characteristics substantiating its possible role as a precursor of ovarian cancer. OBJECTIVE To assess the quality of the literature regarding the association between endometriosis and ovarian cancer and to estimate the extent of this relation. METHODS An electronic literature search was conducted in PubMed and 1112 articles dealing with the relation between endometriosis and ovarian cancer were identified. Original articles based on case-control studies, cohort studies and cross-sectional studies were included. Studies consisting of populations with self-reported endometriosis were excluded, as were articles with fewer than 20 cases of ovarian cancer. Twenty-eight studies underwent detailed quality assessments based on the checklists developed by the Scottish Intercollegiate Guidelines Network (SIGN). Meta-analyses were conducted on selected subgroups of ovarian cancer with coexisting endometriosis. RESULTS None of the 28 studies was given the highest possible rating using the SIGN checklists. The risk of ovarian cancer in women with endometriosis was reported to be a standardized incidence ratio of 1.43-8.95, a rate ratio of 1.6-2.88, an odds ratio of 1.34, with a prevalence of ovarian cancer in 2.0-17.0% of women with endometriosis. Conversely, the prevalence of endometriosis in women with ovarian cancer ranged from 3.4 to 52.6%. Meta-analysis results were weakened by heterogeneity. CONCLUSION There is sufficient evidence to conclude that there is an increased risk of developing clear-cell and endometrioid epithelial ovarian cancer for women with histologically verified endometriosis. Nonetheless, prospective cohort studies assessing the relation between endometriosis and ovarian cancer will increase knowledge in this field.
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Affiliation(s)
- Lene N Heidemann
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
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Long term survival of ovarian endometriosis associated clear cell and endometrioid ovarian cancers. Int J Gynecol Cancer 2013; 23:244-8. [PMID: 23314280 DOI: 10.1097/igc.0b013e31827aa0bb] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This study aimed to analyze long-term survival of clear cells (CCs) and endometrioid (E) ovarian cancer cases according to presence of endometriosis in the pathologic report. METHODS This is a retrospective analysis of 47 CC and 66 E ovarian cancer cases observed consecutively at our center between 1990 and 2010.All cases had first surgery at our center or were referred to it for treatment and follow-up.Cases were identified according to the original diagnosis reported in clinical records.All pathologic reports were reviewed, and cases were classified with or without pathologic evidence of endometriosis on the basis of the pathologic report.Follow-up was updated in March 2011. The follow-up median was 147 months (range, 116-171). RESULTS Endometriosis-associated ovarian cancer cases were more frequently diagnosed at stage I to II than cases without endometriosis: among the 36 endometriosis-associated ovarian cancer cases, 25 (69%) were at stage I or II, and the corresponding value was 35 (46%) of 77 among cases without endometriosis (P = 0.0173).The presence of endometriosis tended to be associated with a higher 10-year survival rate: after taking the potential confounding effect of stage into account, the finding was not statistically significant (hazards ratio, 0.7; 95% confidence interval, 0.3-1.5). CONCLUSIONS This analysis shows that EA CCs and E ovarian cases are diagnosed at an earlier stage than cases without endometriosis. No clear association emerged between presence of endometriosis and survival.
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Malignant transformation of endometrioma in a woman with a history of ovulation induction and in vitro fertilization. Case Rep Med 2012; 2012:497362. [PMID: 23304157 PMCID: PMC3529507 DOI: 10.1155/2012/497362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 12/02/2022] Open
Abstract
Our aim is to document a case of endometrioid adenocarcinoma of the ovary found in an endometriotic cyst that was suspected on pelvic ultrasound in a patient with polycystic ovary syndrome, normal Ca125, and a recent history of ovulation induction for IVF. She underwent an exploratory laparotomy with left salpingo-oophorectomy and omental biopsies followed by reexploration, complete staging, and modified radical abdominal hysterectomy and right salpingo-oophorectomy. An endometrioma described as suspicious for malignancy by an experienced ultrasound examiner should prompt immediate referral to a gynecological oncologist irrespective of Ca125 levels especially in women with a history of ovulation induction and endometriosis.
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Pejovic T, Nezhat F. Effect of Screening on Ovarian Cancer Mortality: The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. J Minim Invasive Gynecol 2011. [DOI: 10.1016/j.jmig.2011.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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The association between endometriosis and ovarian cancer: a review of histological, genetic and molecular alterations. Gynecol Oncol 2011; 124:164-9. [PMID: 22032835 DOI: 10.1016/j.ygyno.2011.10.001] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 09/24/2011] [Accepted: 10/01/2011] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This article represents a review of histologic and genetic findings in endometriosis and describes the mechanisms whereby genetic and non-genetic factors potentially contribute to the neoplastic progression of endometriosis. METHODS Literature review of the English language literature based on searching in the MEDLINE (PubMed) database and additional collection of reports by systematically reviewing all references from retrieved papers. RESULTS Atypical endometriosis seems to represent a transition from benign endometriosis to carcinoma. Endometriosis is characterized by genetic instability: like neoplasms endometriosis seems to be monoclonal in origin, several studies have documented loss of heterozygosity (LOH) in endometriosis, data suggest that mutation of the tumor suppressor gene PTEN play a part in the malignant transformation of endometriosis, some studies have revealed TP53 mutations in endometriotic lesions, and mutation of ARID1A seems to be an important early event in the malignant transformation of endometriosis to endometrioid and clear cell carcinomas. Heme and iron induced oxidative stress, inflammation, and hyperestrogenism are possible links between endometriosis and cancer. CONCLUSIONS The histological and genetic alterations in endometriosis seem to explain why endometriosis can be a precursor of some ovarian cancers, especially clear cell and endometrioid carcinomas. However, the exact molecular mechanisms that may lead to this malignant transformation of endometriosis are not completely understood. More and larger studies are needed to clarify how exactly endometriotic tissue undergoes malignant transformation.
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Vaysse C, Touboul C, Filleron T, Mery E, Jouve E, Leguevaque P, Morice P, Leblanc E, Querleu D. Early stage (IA-IB) primary carcinoma of the fallopian tube: case-control comparison to adenocarcinoma of the ovary. J Gynecol Oncol 2011; 22:9-17. [PMID: 21607090 PMCID: PMC3097339 DOI: 10.3802/jgo.2011.22.1.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Revised: 11/24/2010] [Accepted: 12/01/2010] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Early stage primary carcinoma of the fallopian tube (PCFT) is an uncommon condition when strict criteria are applied. The aim of this study was to compare the outcome stage IA-IB PCFT to a matched group of ovarian cancer (OC). METHODS Between 1990 and 2008, 32 patients with stage IA-IB of PCFT were recorded in the database of three French Institutions. A control group of patients with OC was constituted. RESULTS Eleven eligible PCFT cases and 29 OC controls fulfilled the stringent inclusion criteria. Median follow-up was 70.2 months. Five-year overall survival was 83.3% (95% confidence interval [CI], 27.3 to 97.5) for PCFT and 88.0% (95% CI, 66.9 to 96.0) for OC (p=0.93). In the subgroup of patients with grade 2-3, the outcome was similar in PCFT compared to OC patients (p=0.75). Five-year relapse-free survival was respectively 62.5% (95% CI, 22.9 to 86.1) and 85.0% (95% CI, 64.6 to 94.2) in the PCFT and OC groups (p=0.07). In the subgroup of patients (grade 2-3), there was no difference between PCFT and OC (p=0.65). CONCLUSION The findings did not reveal any difference in prognosis between early stage of PCFT and OC when grade is taken into account. Management of PCFT should mirror that of ovarian carcinoma.
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Affiliation(s)
- Charlotte Vaysse
- Department of Surgery, Institut Claudius Regaud, Toulouse, France
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Munksgaard PS, Blaakaer J. The association between endometriosis and gynecological cancers and breast cancer: a review of epidemiological data. Gynecol Oncol 2011; 123:157-63. [PMID: 21742370 DOI: 10.1016/j.ygyno.2011.06.017] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/10/2011] [Accepted: 06/14/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This article critically reviews the literature on the association between endometriosis and gynecological cancers and breast cancer, based on epidemiologic data. METHODS Literature review of the English language literature based on searching in the MEDLINE (PubMed) database and additional collection of reports by systematically reviewing all references from retrieved papers. RESULTS Data from large cohort and case-control studies indicate that endometriosis patients only have an increased risk of ovarian cancer among the gynecological malignancies and breast cancer, although most of the observed associations are modest. Data on the association between endometriosis and breast cancer are inconsistent. Endometriosis patients have a reduced risk of cervical cancer, and there is no association between endometriosis and endometrial cancer. Endometriosis-associated ovarian cancer seems to be a distinct clinical entity; patients are younger, diagnosed in earlier stages, have lower grade lesions and a better survival. Further, endometriosis-associated ovarian cancers are predominantly clear cell and endometrioid histologic subtypes. CONCLUSIONS Endometriosis seems to be a precursor of epithelial ovarian cancer, especially clear cell and endometrioid adenocarcinomas. However, current evidence is insufficient to draw any definitive conclusions whether this association represents causality or the sharing of similar risk factors and/or antecedent mechanisms.
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Lim MC, Chun KC, Shin SJ, Lee IH, Lim KT, Cho CH, Park SY, Nam JH. Clinical presentation of endometrioid epithelial ovarian cancer with concurrent endometriosis: a multicenter retrospective study. Cancer Epidemiol Biomarkers Prev 2010; 19:398-404. [PMID: 20086106 DOI: 10.1158/1055-9965.epi-09-0750] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Endometrioid epithelial ovarian cancer (EEOC) is frequently diagnosed in conjunction with endometriosis and is suggested to arise during the process of endometriosis. This study evaluates the clinical manifestations, including endometriosis-related symptoms and their relationships according to the coexistence of endometriosis. METHODS Using medical records, a retrospective analysis was conducted on 221 patients treated for EEOC at four tertiary educational hospitals between 2000 and 2008. The initial presenting symptoms, particularly those related to endometriosis, were examined in relation to the coexistence of endometriosis or other clinical variables. RESULTS Endometriosis was identified in 82 (37.1%) of the 221 patients with EEOC. The most common symptoms were pelvic pain followed by gastrointestinal symptoms, palpable mass, abdominal distension, vaginal bleeding, and newly developed or exacerbated dysmenorrhea (18.1%) and dyspareunia (13.6%). Notably, dysmenorrhea and dyspareunia were frequently observed in patients with endometriosis. Among 210 patients identified with pretreatment serum CA-125, 54 (25.7%) displayed normal CA-125 levels (<35 units/mL) and 23.3% and 29.9% of patients without and with endometriosis had normal CA-125 levels, respectively (P = 0.381). Additionally, 32.6% of the patients with early-stage EEOC displayed normal CA-125 levels. CONCLUSIONS In this large series of patients with EEOC, the main presenting symptoms were pelvic pain followed by gastrointestinal symptoms, palpable mass, abdominal distension, vaginal bleeding, and newly developed or exacerbated dysmenorrhea and dyspareunia. Dyspareunia and dysmenorrhea were more frequently detected in patients with endometriosis. Normal CA-125 levels cannot be applied as a marker to exclude EEOC, particularly at the early stages.
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Affiliation(s)
- Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
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Aris A. Endometriosis-associated ovarian cancer: A ten-year cohort study of women living in the Estrie Region of Quebec, Canada. J Ovarian Res 2010; 3:2. [PMID: 20205767 PMCID: PMC2822768 DOI: 10.1186/1757-2215-3-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 01/19/2010] [Indexed: 02/05/2023] Open
Abstract
Objectives Endometriosis has been believed to increase the risk of developing ovarian cancer, but recent data supporting this hypothesis are lacking. The aim of this study was to verify whether the incidence of endometriosis, ovarian cancer and the both increased during the last 10 years among women living in the Estrie region of Quebec. Methods We collected data of women diagnosed with endometriosis, ovarian cancer or both, between 1997 and 2006, from a population living in the Estrie region of Quebec. We performed this retrospective cross-sectional study from the CIRESSS (Centre Informatisé de Recherche Évaluative en Services et Soins de Santé) system, the database of the CHUS (Centre Hospitalier Universitaire of Sherbrooke), Sherbrooke, Canada. Results Among the 2854 identified patients, 2521 had endometriosis, 292 patients had ovarian cancer and 41 patients had both ovarian cancer and endometriosis. We showed a constant increase in the number of ovarian cancer (OC) between 1997 and 2006 (r2 = 0.557, P = 0.013), which is not the case for endometriosis (ENDO) or endometriosis-associated ovarian cancer (EAOC). The mean age ± SD was 40.0 ± 9.9 and 53.9 ± 11.4 for patients having ENDO and OC, respectively. Mean age of women with EAOC was 48.3 ± 10.8, suggesting an early onset of ovarian cancer in women having endometriosis of about 5.5 years average, P = 0.003. Women with ENDO were at increased risk for developing OC (Rate Ratio [RR] = 1.6; 95% Confidence Interval [CI] = 1.12-2.09). Pathological analyses showed the predominance of endometrioid type (24.4%) and clear-cell type (21.9%) types in EAOC compared to OC, P = 0.0070 and 0.0029, respectively. However, the serous type is the most widespread in OC (44.5%) in comparison to EAOC (19.51%), P = 0.0023. Conclusion Our findings highlight that the number of cases of ovarian cancer is constantly increasing in the last ten years and that endometriosis represents a serious risk factor which accelerates its apparition by about 5.5 years.
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Affiliation(s)
- Aziz Aris
- Department of Obstetrics and Gynecology, Sherbrooke University Hospital Centre, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4 Canada.
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Prediagnostic symptoms of ovarian carcinoma: a case-control study. Gynecol Oncol 2009; 114:231-6. [PMID: 19464044 DOI: 10.1016/j.ygyno.2009.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Revised: 04/29/2009] [Accepted: 05/01/2009] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Women with ovarian carcinoma experience poor survival because symptoms are vague and diagnosis is unlikely at an early stage. The objective of this study was to identify a set of symptoms that might assist gynecologists and other clinicians in the diagnosis of localized ovarian carcinoma when treatment is most effective. METHODS This population-based case-control study included 432 women, aged 19-88 years, with invasive ovarian carcinoma and 491 controls frequency-matched to cases on age, ethnicity, and interview time. Symptoms data were collected using interviewer-administered questionnaires. Odds ratios and 95% confidence intervals for the association of symptoms with ovarian carcinoma by stage and histology were estimated using unconditional multiple polytomous logistic regression models. The predictive ability of symptoms was evaluated by comparing the area under receiver operating curves (ROC). RESULTS The following self-reported symptoms were significantly predictive of localized ovarian carcinoma irrespective of histological type: abdominal pain (ROC=0.81), distended and hard abdomen (ROC=0.83), vaginal bleeding not associated with periods (ROC=0.88), and a palpable abdominal mass (ROC=0.88). Urinary symptoms had low predictive ability, and bowel symptoms and fatigue/loss of appetite were predictive only at advanced stages. The best predictive ability was observed for a 4-symptom index that included abdominal pain, distended and hard abdomen, abdominal mass, and abnormal vaginal bleeding (ROC=0.90 sensitivity=74%; specificity=71%). CONCLUSION Greater awareness of the symptoms potentially related to ovarian cancer might lead to earlier diagnosis and might improve survival.
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Nezhat F. Reply of the Authors: CA-125 as a biomarker for malignant transformation of endometriosis. Fertil Steril 2009. [DOI: 10.1016/j.fertnstert.2009.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liu CS, Nagarsheth NP, Nezhat FR. Laparoscopy and Ovarian Cancer: A Paradigm Change in the Management of Ovarian Cancer? J Minim Invasive Gynecol 2009; 16:250-62. [DOI: 10.1016/j.jmig.2009.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 12/29/2008] [Accepted: 01/08/2009] [Indexed: 11/26/2022]
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Nezhat FR, Ezzati M, Chuang L, Shamshirsaz AA, Rahaman J, Gretz H. Laparoscopic management of early ovarian and fallopian tube cancers: surgical and survival outcome. Am J Obstet Gynecol 2009; 200:83.e1-6. [PMID: 19019337 DOI: 10.1016/j.ajog.2008.08.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 03/26/2008] [Accepted: 08/07/2008] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the role of laparoscopy for staging of early ovarian cancers. STUDY DESIGN Case series conducted at the University Hospital with 36 patients who had presumed early-stage adnexal cancers. Laparoscopic staging/restaging was performed. RESULTS Cases included 20 invasive epithelial tumors, 11 borderline tumors, and 5 nonepithelial tumors. Mean number of peritoneal biopsies, paraaortic nodes, and pelvic nodes were 6, 12.23, and 14.84, respectively. Eighty-three percent of the patients had laparoscopic omentectomy. On final pathology, 7 patients were upstaged. Postoperative complications included 1 small bowel obstruction, 2 pelvic lymphoceles, and 1 lymphocele cyst. Mean duration of follow-up is 55.9 months. Three patients had recurrences. All patients are alive without evidence of the disease. CONCLUSION This represents 1 of the largest series and longest follow-ups of laparoscopic staging for early-stage adnexal tumors. Laparoscopic staging of these cancers appears to be feasible and comprehensive without compromising survival when performed by gynecologic oncologists experienced with advanced laparoscopy.
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Nezhat F, Datta MS, Hanson V, Pejovic T, Nezhat C, Nezhat C. The relationship of endometriosis and ovarian malignancy: a review. Fertil Steril 2008; 90:1559-70. [PMID: 18993168 DOI: 10.1016/j.fertnstert.2008.08.007] [Citation(s) in RCA: 165] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 08/05/2008] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To review the malignant potential of endometriosis based on epidemiologic, histopathologic, and molecular data. DESIGN Literature review. RESULT(S) The pathogenesis of endometriosis remains unclear. The histopathologic development of endometriosis has undergone long-term investigation. Studies have confirmed histologic transition from benign endometriosis to ovarian malignancy, including malignant transformation of extraovarian endometriosis. The prevalence of endometriosis in patients with epithelial ovarian cancer, especially in endometrioid and clear cell types, has been confirmed to be higher than in the general population. Ovarian cancers and adjacent endometriotic lesions have shown common genetic alterations, such as PTEN, p53, and bcl gene mutations, suggesting a possible malignant genetic transition spectrum. Furthermore, endometriosis has been associated with a chronic inflammatory state leading to cytokine release. These cytokines act in a complex system in which they induce or repress their own synthesis and can cause unregulated mitotic division, growth and differentiation, and migration or apoptosis similar to malignant mechanisms. CONCLUSION(S) The malignant potential of endometriosis holds serious implications for management, such as the need for earlier and more meticulous surgical intervention for complete disease treatment.
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Affiliation(s)
- Farr Nezhat
- Department of Obstetrics, Mount Sinai Medical Center, New York, New York 10019, USA.
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Jarboe EA, Folkins AK, Drapkin R, Ince TA, Agoston ES, Crum CP. Tubal and ovarian pathways to pelvic epithelial cancer: a pathological perspective. Histopathology 2008; 53:127-38. [PMID: 18298580 DOI: 10.1111/j.1365-2559.2007.02938.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Prolongation of ovarian epithelial cancer survival depends on early detection or improved responses to chemotherapy. Gains in either have been modest at best. Understanding the diverse pathogenesis of this disease is critical to early intervention or prevention. This review addresses six important variables, including (i) cell of origin, (ii) site of origin, (iii) initial genotoxic events, (iv) risks imposed by hereditary and other promoting conditions, (v) subsequent factors that promote different patterns of metastatic spread, and (vi) prospects for intervention. This review proposes two distinct pathways to pelvic epithelial cancer. The first initiates in ovarian surface epithelium (OSE), Mullerian inclusions or endometriosis in the ovary. The second arises from the endosalpinx and encompasses a subset of serous carcinomas. The serous carcinogenic sequence in the distal fallopian tube is described and contrasted with lower grade serous tumors based on tumour location, earliest genetic change and ability (or lack of) to undergo terminal (ciliated) differentiation. Ultimately, a clear understanding of tumour origin and the mechanism(s) leading to the earliest phases of the serous and endometrioid carcinogenic sequences may hold the greatest promise for designing prevention strategies and/or developing new therapies.
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Affiliation(s)
- E A Jarboe
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
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