Clear cell carcinoma arising in endometriosis of the rectum following progestin therapy

Malignancies Associated with Extraovarian Endometriosis: A Literature Review

Endometriosis-associated ovarian malignancies have been well documented. Although these malignancies also occur as extraovarian lesions, little is known about them. Thus, this literature review aimed to further explore these rarely experienced tumors. A total of 257 published cases between April 1990 and April 2020 were found using PubMed, and 212 cases were included in the analysis considering Sampson’s criteria and the history of endometriosis. We classified these cases as follows: intestine, abdominal scar, vagina and vulva, peritoneum and deep endometriosis, urinary tract, uterine cervix, and others. Age of patients, history of endometriosis, types of past hormonal therapy, symptoms, histological types, and treatment were identified. The most common tumor site was the intestine. Endometrioid carcinoma was the dominant histological type. Contrary to the ovary, clear cell carcinoma was rare in extraovarian sites. On the other hand, clear cell carcinoma represented the largest number of abdominal scars. This difference may help us to understand the development of endometriosis-related malignancies. Hormonal treatment was mentioned in 67 cases and estrogen replacement therapy in 33 cases. Although risks of estrogen therapy are still controversial, the highly differentiated histological types and hormone-dependent characteristics of endometriosis-associated malignancy should be considered. Physicians should be careful about estrogen monotherapy after hysterectomy and long-term hormone replacement therapy in patients with a history of endometriosis.

Endometrioid Adenocarcinoma Arising from Intestinal Endometriosis

Purpose

Gastrointestinal involvement of endometriosis may exist in up to 37% of women suffering from endometriosis, but malignant transformation of intestinal endometriosis is extremely rare. In this case report, we present a case of endometrioid adenocarcinoma arising from 2 different large bowel endometriotic sites, with a review of the reported cases of epithelial malignancies developed in gastrointestinal endometriosis.

Case

A 33-year-old nulligravid Japanese woman was admitted for the evaluation of massive ascites. The patient had undergone a laparoscopic bilateral cystectomy for bilateral endometriomas 8 years before. At laparotomy, we found massive serous ascites, diffuse peritoneal endometriotic lesions, edematous gastrointestinal tract with small surface nodules, stenosis of the sigmoid colon and firm and thick peritoneum. No endometriotic or tumorous lesions were found in the genital tract. The patient underwent a resection of the sigmoid colon, partial resection of the transverse colon, partial omentectomy and multiple biopsies of the peritoneum and ovaries. On the histologic examination, benign endometriosis, atypical hyperplasia and grade 1 endometrioid adenocarcinoma were found to be present in the transverse and sigmoid colon. Subsequently, the patient was treated with chemotherapy consisting of paclitaxel and carboplatin under a diagnosis of endometrioid adenocarcinoma arising in the intestinal endometriosis. The patient is well without evidence of disease 26 months following the surgery.

Conclusions

The tumors arising from intestinal endometriosis can clinically and pathologically mimic primary neoplasms of the gastrointestinal tract. Recognition of these lesions is important because primary gastrointestinal neoplasms are managed differently from those arising in endometriosis, and these differences may have significant clinical implications.

[Postmenopausal malignant transformation of extragenital endometriosis. A case report]

Malignant transformation of endometriosis is a rare event. The ovaries are the most common sites reported in the literature. Postmenopausal cancer arising in extragenital endometriosis is still more exceptional. Hormone replacement therapy and perhaps, to a lesser extent, Tamoxifen could be risk factors for the malignant transformation of endometriosis. We herein report the case of a patient who has developed, after 11 years of hormone replacement therapy, an extragenital endometrioid carcinoma in the vesico-uterine pouch.

[Intestinal endometriosis. Current status]

Endometriosis affects a wide spectrum of premenopausal women. Intestinal involvement, affecting mainly the large bowel and sometimes the small bowel, is much less frequent. Diagnosis is relatively straightforward in women with long standing pelvic endometriosis but is difficult in acute intestinal obstruction, since a diagnosis of endometriosis is not often considered in this entity. We performed an exhaustive review of the medical literature, including the option of medical treatment, which is rarely effective in intestinal endometriosis. In most patients with intestinal symptoms, the disease is so severe that surgical treatment is required. Recent studies indicate that the most effective approach is laparoscopic. We analyze the most important classical and recent series of patients and discuss treatment results.

Hormone replacement therapy in women with past history of endometriosis

Endometriosis is a common clinical condition and its treatment will often lead to an estrogen deficiency status. As most of these patients are young, they will need to consider hormone replacement therapy. Endometriosis is a hormone-dependent disease and estrogen replacement can be associated with a risk of recurrence or malignant transformation. Only a few studies have addressed this problem. With the use of hormone replacement therapy (HRT), there is an increased, although undefined, risk of recurrence of endometriosis, especially in known severe cases and in obese patients. Unopposed estrogen appears to carry a higher risk than combined preparations. Delay in starting HRT after pelvic clearance is not of any benefit. After radical surgery for severe endometriosis, women often have much to gain from HRT, particularly in the early years. Benefits of HRT in terms of control of menopausal symptoms, prevention of urogenital atrophy and loss of libido and bone protection are of particular importance. HRT may still have a role in prevention of cardiovascular disease in early menopause, but this remains unproven. Although there is no firm evidence, continuous combined preparations or tibolone would appear to be the optimum choice.

Endometriosis-Associated Ovarian Cancer: A Clinicopathologic Review

Endometriosis is a common clinical disorder in women and usually presents with pelvic pain, infertility, or adnexal masses secondary to intracystic hemorrhage with the formation of an endometrioma. Endometriosis shares certain characteristics with malignant neoplasms, and malignant ovarian tumours have been documented in women with endometriosis. Endometriosis-associated ovarian cancer (EAOC) usually occurs in younger women, has favourable outcomes, and appears as either a low-grade tumour of endometrioid cell type or as a clear cell tumour. As it has been suggested that the pathologic features of "atypical endometriosis" may constitute a precancerous state, women with atypical endometriosis may be at an increased risk of developing EAOC. There are no prospective randomized trials assessing treatment regimens for EAOC. Most women receive treatment similar to other epithelial ovarian cancers. However, women with EAOC represent a subgroup of patients that may require different therapeutic options. English-language journals indexed in MEDLINE and PubMed were searched for relevant articles that evaluated the association between endometriosis and ovarian cancer, theories of pathogenesis and transformation, the clinical presentation and pathologic features of EAOC, as well as the treatment options available.

Unusual retrorectal lesion

Retrorectal lesions are rare entities. We report the complete clinicopathological details of an unusual retrorectal lesion composed of low-grade endometrioid adenocarcinoma and propose that this is a malignant change in pluripotent cells arising within a long-standing retrorectal tailgut lesion. To the best of our knowledge, this is the first case report of this malignancy in a retrorectal tailgut cyst.