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Chen B, Zhao L, Yang R, Xu T. New insights about endometriosis-associated ovarian cancer: pathogenesis, risk factors, prediction and diagnosis and treatment. Front Oncol 2024; 14:1329133. [PMID: 38384812 PMCID: PMC10879431 DOI: 10.3389/fonc.2024.1329133] [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: 10/28/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Previous studies have shown that the risk of malignant transformation of endometriosis in premenopausal women is approximately 1%, significantly impacting the overall well-being and quality of life of affected women. Presently, the diagnostic gold standard for endometriosis-associated ovarian cancer (EAOC) continues to be invasive laparoscopy followed by histological examination. However, the application of this technique is limited due to its high cost, highlighting the importance of identifying a non-invasive diagnostic approach. Therefore, there is a critical need to explore non-invasive diagnostic methods to improve diagnostic precision and optimize clinical outcomes for patients. This review presents a comprehensive survey of the current progress in comprehending the pathogenesis of malignant transformation in endometriosis. Furthermore, it examines the most recent research discoveries concerning the diagnosis of EAOC and emphasizes potential targets for therapeutic intervention. The ultimate objective is to improve prevention, early detection, precise diagnosis, and treatment approaches, thereby optimizing the clinical outcomes for patients.
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Affiliation(s)
| | | | | | - Tianmin Xu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
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2
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Wang H, Chen C, Wang D, Zhu Y, Chen P. Correlation of clinicopathological and prognostic characteristics between endometriosis-associated and primary ovarian cancer. BMC Cancer 2023; 23:1210. [PMID: 38066448 PMCID: PMC10704787 DOI: 10.1186/s12885-023-11641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The main aim of this study was to establish the clinicopathological and prognostic correlations between endometriosis-associated and non-endometriosis-associated primary ovarian cancer, with a view to providing a reference guide for revision of diagnostic criteria for malignant transformation of endometriosis. METHODS Clinicopathological and follow-up data of 174 patients with clear cell and endometrial ovarian cancer were retrospectively extracted. Cases were divided into endometriosis-associated and non-endometriosis-associated primary ovarian cancer for comparative analysis of clinicopathological characteristics and prognosis. RESULTS Average age and post-menopausal rate in the endometriosis-associated ovarian cancer group were lower relative to the primary ovarian cancer group (P < 0.05). Body mass index, age at menopause, operation history, dysmenorrhea, complications, tumor size, tumor side, ascites, CA125, HE4, CA19.9, stage, differentiation, expression of ER, PR, P53, P16, Ki67, MMR, HNF-1β and Napsin A were not significantly different between the groups (P > 0.05). Furthermore, rates of resistance to platinum chemotherapy, relapse, progression-free survival and overall survival were comparable between the two groups (P > 0.05). CONCLUSION Endometriosis-associated and primary ovarian cancers of the same pathological type are speculated to be homologous in terms of origin from malignant transformation of endometriosis. It may therefore be necessary to revise the diagnostic criteria for ovarian endometriosis malignancy.
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Affiliation(s)
- Huimin Wang
- Department of Gynecology, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, Dadong District, Shenyang, Liaoning, 110004, China
| | - Cong Chen
- Department of Gynecology, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, Dadong District, Shenyang, Liaoning, 110004, China
| | - Danbo Wang
- Department of Gynecology, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, Dadong District, Shenyang, Liaoning, 110004, China.
| | - Yanmei Zhu
- Department of Pathology, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China.
| | - Peng Chen
- Department of Gynecology, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, Dadong District, Shenyang, Liaoning, 110004, China
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Kundur M, Bhati P, Girish BK, Sheejamol VS, Nair IR, Pavithran K, Rajanbabu A. Endometriosis in clear cell and endometrioid carcinoma ovary: its impact on clinicopathological characteristics and survival outcomes. Ecancermedicalscience 2023; 17:1591. [PMID: 37799950 PMCID: PMC10550295 DOI: 10.3332/ecancer.2023.1591] [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: 05/09/2023] [Indexed: 10/07/2023] Open
Abstract
Background Malignant transformation in endometriosis was first described by Sampson in 1925. There is now sufficient evidence of its association specifically with endometrioid (EOC) and clear cell ovarian cancer (CCOC). Whether endometriosis-associated ovarian cancer (EAOC) is a distinct clinicopathological entity from non-endometriosis-associated ovarian cancer (NEAOC) remains uncertain. Objectives This study aimed to assess the impact of endometriosis on clinical characteristics and survival outcomes in EOC and CCOC. Methods This is a retrospective single-institution analysis of patients diagnosed with CCOC AND EOC between 2010 and 2021. Demographic and clinical presentation data were obtained from medical records. Patients were followed up till March 2023. Statistical analysis was done using the IBM SPSS Statistics 20 Windows. Results Of the 77 cases of CCOC and EOC ovary, 38 had histopathologically proven endometriosis. There was no difference in age (51.62 and 50.05 years, respectively), body mass index, parity, menopausal status and CA 125 levels at presentation. Ascites was more frequent in the absence of endometriosis (30% versus 8.1%, p = 0.015). However, this did not translate to a statistical difference in the stage, with the majority presenting in the early stage. (94% versus 83%). All 78 patients underwent primary cytoreduction with equal rates of optimal resection.There was no difference in the mean disease-free interval between EAOC and NEAOC (107.6 and 109.4 months, p 0.484). Recurrences were predominantly pelvic in both groups. The disease-specific survival was 111.7 and 120.1 months, respectively, with and without endometriosis. This was however not statistically significant (p 0.751). Conclusion In the Indian population, endometriosis did not have any impact on the age at presentation, CA 125 levels, stage of the disease and survival outcomes in EOC and CCOC ovary.
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Affiliation(s)
- Mythili Kundur
- Department of Gynaecological Oncology, Amrita Institute of Medical Sciences, Kochi 682024, India
| | - Priya Bhati
- Department of Gynaecological Oncology, Amrita Institute of Medical Sciences, Kochi 682024, India
| | - Burde Kaustubh Girish
- Department of Gynaecological Oncology, Amrita Institute of Medical Sciences, Kochi 682024, India
| | - VS Sheejamol
- Department of Biostatistics, Amrita Institute of Medical Sciences, Kochi 682024, India
| | - Indu R Nair
- Department of Pathology, Amrita Institute of Medical Sciences, Kochi 682024, India
| | - Keechilat Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi 682024, India
| | - Anupama Rajanbabu
- Department of Gynaecological Oncology, Amrita Institute of Medical Sciences, Kochi 682024, India
- James Cook University Hospital, Middlesbrough TS4 3BW, UK
- https://orcid.org/0000-0002-2885-8098
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Sun Y, Liu G. Endometriosis-associated Ovarian Clear Cell Carcinoma: A Special Entity? J Cancer 2021; 12:6773-6786. [PMID: 34659566 PMCID: PMC8518018 DOI: 10.7150/jca.61107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/12/2021] [Indexed: 02/06/2023] Open
Abstract
Endometriosis is an estrogen-dependent disease, which serves as a precursor of ovarian cancer, especially clear cell carcinoma (OCCC) and endometrial carcinoma. Although micro-environmental factors such as oxidative stress, immune cell dysfunction, inflammation, steroid hormones, and stem cells required for malignant transformation have been found in endometriosis, the exact carcinogenic mechanism remains unclear. Recent research suggest that many putative driver genes and aberrant pathways including ARID1A mutations, PIK3CA mutations, MET activation, HNF-1β activation, and miRNAs dysfunction, play crucial roles in the malignant transformation of endometriosis to OCCC. The clinical features of OCCC are different from other histological types. Patients usually present with a large, unilateral pelvic mass, and occasionally have thromboembolic vascular complications. OCCC patients are easier to be resistant to chemotherapy, have a worse prognosis, and are usually difficult to treat. To improve the survival of OCCC patients, it is necessary to better understand its specific carcinogenic mechanism and explore new treatment strategy, including molecular target.
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Affiliation(s)
- Yue Sun
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin, 300052, China
| | - Guoyan Liu
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin, 300052, China
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Park SJ, Lim W, Mun J, Paik H, Park S, Lim H, Kim J, Lee EJ, Yim GW, Lee N, Lee C, Kim JW, Song G, Kim HS. SERPINB11 Expression Is Associated With Prognosis of High-grade Serous and Clear Cell Carcinoma of the Ovary. In Vivo 2021; 35:2647-2653. [PMID: 34410952 DOI: 10.21873/invivo.12547] [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: 03/16/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To evaluate the role of serine protease inhibitor B11 (SERPINB11) expression as a prognostic biomarker in high-grade serous carcinoma (HGSC) and clear cell carcinoma of the ovary (CCC). MATERIALS AND METHODS We obtained tumor tissues from patients with HGSC (n=145) and CCC (n=59). We evaluated immunohistochemically the expression of SERPINB11 and investigated whether SERPINB11 expression affects platinum-resistance and the prognosis of HGSC and CCC. RESULTS High expression of SERPINB11 was more common in CCC than in HGSC (57.6% vs. 28.3%; p<0.01), and SEPRINB11 expression did not correlate with platinum-resistance of HGSC and CCC. High expression of SERPINB11 was associated with worse progression-free survival and overall survival with marginal significance in HGSC; no relation between SERPINB11 expression and the prognosis of CCC was found. CONCLUSION SERPINB11 expression maybe a prognostic biomarker for HGSC.
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Affiliation(s)
- Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Whasun Lim
- Department of Food and Nutrition, Kookmin University, Seoul, Republic of Korea
| | - Jaehee Mun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Haerin Paik
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sunwoo Park
- Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Hyunji Lim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junhwan Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Ji Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ga Won Yim
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Nara Lee
- Department of Obstetrics & Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Cheol Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gwonhwa Song
- Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea;
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea;
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6
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Zhou L, Yao L, Dai L, Zhu H, Ye X, Wang S, Cheng H, Ma R, Liu H, Cui H, Chang X. Ovarian endometrioid carcinoma and clear cell carcinoma: A 21-year retrospective study. J Ovarian Res 2021; 14:63. [PMID: 33941230 PMCID: PMC8094516 DOI: 10.1186/s13048-021-00804-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/05/2021] [Indexed: 11/28/2022] Open
Abstract
Objective This study aimed to identify the clinical characteristics of Chinese patients with ovarian endometrioid carcinoma (EC) and clear cell carcinoma (CCC) and to assess the impact of concurrent endometriosis on this group. Methods The present study reviewed the medical records of patients who received initial treatment and a postoperative pathological diagnosis of EC or CCC at our center in China between 1998 and 2018. Results Of 211 patients, 73 had pure EC, and 91 had pure CCC, and the remaining 47 had mixed cancer. The proportion of EC and CCC remained stable over past 21 years. The proportion of EC declined with aging and the age of EC onset to incline to the young. And the age of CCC onset had two peaks, namely, 36 and 77 years. After review by the pathologist, the number of endometriosis cases found in the pathological section of the analysis increased to 114, accounting for 54% of patients. As the stage progressed, the appearance of endometriosis became increasingly scarce in pathological sections(p = 0.001). Compared with CCC, EC had a higher frequency of concurrent endometrial cancer (independent endometrial lesions) and estrogen and progesterone receptor expression(p = 0.000). And more patients were in premenopausal state in EC group(p = 0.040). In the pure group, multivariate analysis showed that correlation existed between relevance to endometriosis and worse outcomes(p = 0.041). In patients with mixed cancer, mixed endometrioid histology was associated with better survival than other subtypes, even with stage III or poorly differentiated tumors(p = 0.001). Conclusions CCC and EC which are common in ovarian cancer patients who have associated with endometriosis have distinct clinicopathological characteristics. Attention should be paid to ovarian cancer patients with a history of endometriosis and those with concurrent endometriosis in pathological sections. Supplementary Information The online version contains supplementary material available at 10.1186/s13048-021-00804-1.
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Affiliation(s)
- Ling Zhou
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, No. 11, South Avenue, Xi Zhi Men, Xicheng District, Beijing, 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Liqing Yao
- Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Fuding Hospital, Fuding, Fujian Province, China
| | - Lin Dai
- Department of Pathology, Peking University People's Hospital, Beijing, China
| | - Honglan Zhu
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, No. 11, South Avenue, Xi Zhi Men, Xicheng District, Beijing, 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Xue Ye
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, No. 11, South Avenue, Xi Zhi Men, Xicheng District, Beijing, 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Shang Wang
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, No. 11, South Avenue, Xi Zhi Men, Xicheng District, Beijing, 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Hongyan Cheng
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, No. 11, South Avenue, Xi Zhi Men, Xicheng District, Beijing, 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Ruiqiong Ma
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, No. 11, South Avenue, Xi Zhi Men, Xicheng District, Beijing, 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Huiping Liu
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, No. 11, South Avenue, Xi Zhi Men, Xicheng District, Beijing, 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Heng Cui
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, No. 11, South Avenue, Xi Zhi Men, Xicheng District, Beijing, 100044, China.,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China
| | - Xiaohong Chang
- Department of Obstetrics and Gynecology, Center of Gynecologic Oncology, Peking University People's Hospital, No. 11, South Avenue, Xi Zhi Men, Xicheng District, Beijing, 100044, China. .,Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, China.
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Cai Y, Yin J, Jin Y, Li Y, Wu M, Yang J, Huang H, Leng J, Pan L. Endometriosis-associated ovarian cancer is not a distinct clinical entity among young patients: A 12-year cohort study. Eur J Surg Oncol 2019; 46:876-882. [PMID: 31837932 DOI: 10.1016/j.ejso.2019.11.517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/19/2019] [Accepted: 11/29/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To investigate the clinicopathological features and prognostic value of endometriosis in young patients with ovarian endometrioid carcinoma (OEC) and ovarian clear cell carcinoma (OCCC). METHODS The medical files and clinical follow-up data of patients aged 40 years or younger with OEC or OCCC between January 2006 and December 2017 who had undergone complete surgical staging followed by systemic chemotherapy were retrospectively reviewed. RESULTS A total of 94 women were included in this study. Univariate analysis revealed that the progression-free survival (PFS) and overall survival (OS) rates of patients with endometriosis-associated ovarian carcinoma (EAOC) did not improve compared with those of patients without EAOC (5-year PFS: 80.0% vs. 75.9% and 5-year OS: 85.0% vs. 86.0%, respectively). Multivariate analyses confirmed that FIGO stage (II-IV), cytology-positive ascites or peritoneal washes and residual disease > 1 cm were independent predictors of PFS and that residual disease > 1 cm was the only predictor of OS. CONCLUSIONS Endometriosis is not independently associated with the prognosis of OEC and OCCC among young patients. The intrinsic relationship between endometriosis and ovarian cancer warrants further investigation.
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Affiliation(s)
- Yan Cai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jie Yin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Jin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huifang Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinhua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lingya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Moga MA, Bălan A, Dimienescu OG, Burtea V, Dragomir RM, Anastasiu CV. Circulating miRNAs as Biomarkers for Endometriosis and Endometriosis-Related Ovarian Cancer-An Overview. J Clin Med 2019; 8:jcm8050735. [PMID: 31126056 PMCID: PMC6571871 DOI: 10.3390/jcm8050735] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/13/2019] [Accepted: 05/21/2019] [Indexed: 12/30/2022] Open
Abstract
Early detection and accurate diagnosis are pivotal in the management of endometriosis and endometriosis-related ovarian neoplasms (ERONs), yet there is no clear common ground regarding their pathogenesis. Endometriosis is a debilitating pathology that profoundly impairs the quality of life. Although the spontaneous resolution of endometriosis is possible, studies suggest that it can be a progressive condition, and ERONs can develop. The gold standard for diagnosis remains as the invasive method of laparoscopy followed by histological confirmation. In recent years, novel biomarkers have been discovered. MicroRNAs (miRNA) represent important epigenetic modulators of gene expression and are very attractive as biomarkers due to their lower complexity, tissue specificity, and stability in bodily fluids. Several studies have advanced the possibility of miRNAs becoming potential biomarkers in endometriosis and ERONs. Our aim is to bring these studies together in order to have a better understanding of whether, how, and when miRNAs might be used as biomarkers for these pathologies. METHODS We selected the reviewed papers from Google Academic, PubMed, and CrossRef. A total of eight studies met the inclusion criteria. RESULTS MiR-200 family, miR-143, 145, miR-20a, and miR199a were the most commonly dysregulated miRNAs in endometriosis, and miR-200 family was found to be dysregulated in both ERONs and endometriosis. CONCLUSIONS No single miRNA was considered as a sole biomarker for this pathology. However, since the prognostic value of biomarkers is generally enhanced if more are assessed at the same time, a panel of miRNAs could be a better indicator of the disease.
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Affiliation(s)
- Marius Alexandru Moga
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
| | - Andreea Bălan
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
| | - Oana Gabriela Dimienescu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
| | - Victoria Burtea
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
| | - Roxana Maria Dragomir
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
| | - Costin Vlad Anastasiu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
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Endometriosis and ovarian cancer: Their association and relationship. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100053. [PMID: 31404281 PMCID: PMC6687431 DOI: 10.1016/j.eurox.2019.100053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 02/07/2023] Open
Abstract
Objectives To study endometriosis-associated borderline or malignant ovarian epithelial tumors by analyzing their differential clinical features, as well as the histological pattern, survival and immunohistochemical data compared with those without associated endometriosis. Study design Setting: Hospital Marina Baixa and San Juan University Hospital, Alicante, Spain. This retrospective study included clinical and pathological data from 36 operated cases with endometriosis-associated ovarian epithelial tumors and 305 cases of ovarian epithelial tumors without endometriosis, including borderline and invasive tumors. We also studied hormonal receptors and p53 protein expression in 13 cases with endometriosis-associated endometrioid and clear cell tumors, and report two cases with histologically-confirmed previous endometriosis. Results Associated endometriosis was observed in 10.5% of patients with borderline or invasive ovarian epithelial tumor, 53% of those with endometrioid, and 22% with clear cell tumors. Patients with endometriosis-associated ovarian epithelial tumors were younger, had lower parity, were more frequently premenopausal, had a lower tumor stage or were borderline, and in general had better prognosis and longer survival, although they also more frequently had an associated endometrial carcinoma. Associated endometriosis and endometrioid tumors were generally estrogen-receptor positive, whereas they were negative in the clear cell tumor component. p53 protein positivity was generally observed in clear cell tumors and in associated endometriosis. Two reported cases with previous, known endometriosis were followed in their evolution to borderline endometrioid carcinoma and clear cell carcinoma, respectively. Conclusions Our results and review of the literature suggest that the association of ovarian epithelial tumors and endometriosis is a factor for good prognosis for ovarian cancer and that this association might correspond in many cases to an intermediate stage in the development of endometriosis to endometrioid, clear cell, or other invasive carcinomas.
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10
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Choi JY, Han HH, Kim YT, Lee JH, Kim BG, Kang S, Cho NH. Ovarian Clear Cell Carcinoma Sub-Typing by ARID1A Expression. Yonsei Med J 2017; 58:59-66. [PMID: 27873496 PMCID: PMC5122653 DOI: 10.3349/ymj.2017.58.1.59] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/03/2016] [Accepted: 06/08/2016] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Loss of AT-rich DNA-interacting domain 1A (ARID1A) has been identified as a driving mutation of ovarian clear cell carcinoma (O-CCC), a triple-negative ovarian cancer that is intermediary between serous and endometrioid subtypes, in regards to molecular and clinical behaviors. However, about half of O-CCCs still express BAF250a, the protein encoded by ARID1A. Herein, we aimed to identify signatures of ARID1A-positive O-CCC in comparison with its ARID1A-negative counterpart. MATERIALS AND METHODS Seventy cases of O-CCC were included in this study. Histologic grades and patterns of primary tumor, molecular marker immunohistochemistry profiles, and clinical outcomes were analyzed. RESULTS Forty-eight (69%) O-CCCs did not express BAF250a, which were designated as "ARID1A-negative." The other 22 (31%) O-CCCs were designated as "ARID1A-positive." ARID1A-positive tumors were more likely to be histologically of high grades (41% vs. 10%, p=0.003), ERβ-positive (45% vs. 17%, p=0.011), and less likely to be HNF1β-positive (77% vs. 96%, p=0.016) and E-cadherin-positive (59% vs. 83%, p=0.028) than ARID1A-negative tumors. Patient age, parity, tumor stage were not significantly different in between the two groups. Cancer-specific survival was not significantly different either. CONCLUSION We classified O-CCCs according to ARID1A expression status. ARID1A-positive O-CCCs exhibited distinct immunohistochemical features from ARID1A-negative tumors, suggesting a different underlying molecular event during carcinogenesis.
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Affiliation(s)
- Jae Yoon Choi
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ho Han
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Hyun Lee
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Baek Gil Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Suki Kang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute (SBSI), Yonsei University College of Medicine, Seoul, Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute (SBSI), Yonsei University College of Medicine, Seoul, Korea.
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11
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Arakawa N, Kobayashi H, Yonemoto N, Masuishi Y, Ino Y, Shigetomi H, Furukawa N, Ohtake N, Miyagi Y, Hirahara F, Hirano H, Miyagi E. Clinical Significance of Tissue Factor Pathway Inhibitor 2, a Serum Biomarker Candidate for Ovarian Clear Cell Carcinoma. PLoS One 2016; 11:e0165609. [PMID: 27798689 PMCID: PMC5087914 DOI: 10.1371/journal.pone.0165609] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/15/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There is currently no reliable serum biomarker for ovarian clear cell carcinoma (CCC), a highly lethal histological subtype of epithelial ovarian cancer (EOC). Previously, using a proteome-based approach, we identified tissue factor pathway inhibitor 2 (TFPI2) as a candidate serum biomarker for CCC. In this study, we sought to evaluate the clinical diagnostic performance of TFPI2 in preoperative prediction of CCC. METHODS Serum TFPI2 levels were measured in serum samples from a retrospective training set consisting of patients with benign and borderline ovarian tumors, EOC subtypes, and uterine diseases. Via receiver operating characteristic (ROC) analyses, we compared the diagnostic performance of TFPI2 with that of CA125 in discrimination of patients with ovarian CCC from other patient groups. The observed diagnostic performances were examined in a prospective validation set. RESULTS The 268-patient training set included 29 patients with ovarian CCC. Unlike CA125, which was also elevated in patients with endometriosis and several EOC subtypes, serum TFPI2 levels were specifically elevated only in ovarian CCC patients, consistent with the mRNA expression pattern in tumor tissues. The area under the ROC curve (AUC) of serum TFPI2 was obviously higher than that of CA125 for discrimination of CCC from other ovarian diseases (AUC = 0.891 versus 0.595). Applying a cut-off value of 280 pg/mL, TFPI2 could distinguish early-stage (FIGO I and II) CCC from endometriosis with 72.2% sensitivity, 93.3% specificity, and 88.8% accuracy. Similar results were confirmed in an independent 156-patient prospective validation set. CONCLUSIONS TFPI2 is a useful serum biomarker for preoperative clinical diagnosis of CCC.
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MESH Headings
- Adenocarcinoma, Clear Cell/blood
- Adenocarcinoma, Clear Cell/diagnosis
- Adenocarcinoma, Clear Cell/surgery
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Biomarkers, Tumor
- CA-125 Antigen/blood
- Carcinoma, Ovarian Epithelial
- Female
- Genital Diseases, Female/blood
- Genital Diseases, Female/diagnosis
- Glycoproteins/blood
- Humans
- Menstrual Cycle
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- Neoplasms, Glandular and Epithelial/blood
- Neoplasms, Glandular and Epithelial/diagnosis
- Neoplasms, Glandular and Epithelial/surgery
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/diagnosis
- Ovarian Neoplasms/surgery
- Preoperative Period
- Prognosis
- ROC Curve
- Reproducibility of Results
- Young Adult
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Affiliation(s)
- Noriaki Arakawa
- Department of Medical Life Science, Graduate School of Medical Life Science, Yokohama City University, Yokohama, Kanagawa, Japan
- Advanced Medical Research Center, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Hiroshi Kobayashi
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, Center for Novel and Explanatory Clinical Trials (Y-NEXT), Yokohama City University, Yokohama, Kanagawa, Japan
| | - Yusuke Masuishi
- Department of Medical Life Science, Graduate School of Medical Life Science, Yokohama City University, Yokohama, Kanagawa, Japan
- Advanced Medical Research Center, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Yoko Ino
- Department of Medical Life Science, Graduate School of Medical Life Science, Yokohama City University, Yokohama, Kanagawa, Japan
- Advanced Medical Research Center, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Hiroshi Shigetomi
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Naoto Furukawa
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Norihisa Ohtake
- Bioscience Division, Reagent Development Department, Tosoh Corporation, Ayase, Kanagawa, Japan
| | - Yohei Miyagi
- Research Institute, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Fumiki Hirahara
- Yokohama City University Hospital, Department of Obstetrics and Gynecology, Yokohama, Kanagawa, Japan
| | - Hisashi Hirano
- Department of Medical Life Science, Graduate School of Medical Life Science, Yokohama City University, Yokohama, Kanagawa, Japan
- Advanced Medical Research Center, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Etsuko Miyagi
- Yokohama City University Hospital, Department of Obstetrics and Gynecology, Yokohama, Kanagawa, Japan
- * E-mail:
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12
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Bruner-Tran KL, Duleba AJ, Taylor HS, Osteen KG. Developmental Toxicant Exposure Is Associated with Transgenerational Adenomyosis in a Murine Model. Biol Reprod 2016; 95:73. [PMID: 27535957 PMCID: PMC5333937 DOI: 10.1095/biolreprod.116.138370] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 08/10/2016] [Indexed: 01/03/2023] Open
Abstract
The common environmental toxicant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD or, commonly, dioxin) is a known endocrine disruptor that has been linked to the development of endometriosis in experimental models. Using a murine model, we previously demonstrated that in utero TCDD exposure promotes the transgenerational development of an “endometriosis-like” uterine phenotype consisting of reduced responsiveness to progesterone, as well as subfertility and an increased risk of preterm birth. Because adenomyosis is frequently observed as a comorbidity in women with endometriosis, herein we sought to determine the incidence of adenomyosis in nonpregnant mice with a history of direct or indirect TCDD exposure. Using histologic assessment and immunohistochemical staining, we analyzed murine uteri for adenomyosis, microvessel density, and expression of estrogen receptors alpha and beta (ESR1 and ESR2). Our studies revealed that unexposed control mice did not exhibit adenomyosis, whereas this disease was frequently observed in mice with a history of early-life TCDD exposure. A transgenerational impact of developmental TCDD exposure was demonstrated, because a subset of mice with only an indirect exposure (F3) also exhibited adenomyosis. Microvessel density within the uterus was significantly higher in all groups of TCDD-exposed mice compared with control animals, with density correlated to the severity of disease. Both ESR1 and ESR2 proteins exhibited alterations in expression in experimental mice compared with controls. Similar to women with endometriosis, we observed a significant reduction in the ratio of Esr1:Esr2 mRNA in all F1 mice compared with controls. Although this retrospective study was not designed to specifically address mechanisms associated with the development of adenomyosis, our data suggest that developmental TCDD exposure permanently alters adult steroid responses, which may contribute to the transgenerational development of adenomyosis.
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Affiliation(s)
- Kaylon L. Bruner-Tran
- Women's Reproductive Health Research Center, Department of Obstetrics & Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
- Correspondence: Kaylon L. Bruner-Tran, Vanderbilt University Medical Center, Women's Reproductive Health Research Center, 1161 21st Ave. S., MCN B-1100, Nashville, TN 37232. E-mail:
| | - Antoni J. Duleba
- Department of Reproductive Medicine, University of California, San Diego, San Diego, California
| | - Hugh S. Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Kevin G. Osteen
- Women's Reproductive Health Research Center, Department of Obstetrics & Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Nashville, Tennessee
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13
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Abstract
Endometriosis is manifested by the presence of both endometrial glandular and stromal cells outside the uterine cavity. It is characterized by ectopic implantation of endometrial cells with elevated proliferation and migration. Endometriosis is the leading cause of morbidity among premenopausal women and the complex pathogenesis of this disease remains controversial despite extensive research. This rather complex disease has a significant impact on quality of life of many women as none of the current treatments represent a cure. Based on the current knowledge, one can conclude that the histological and genetic alterations in endometriosis might explain why and how endometriosis can change into several types of cancer. However, the exact mechanisms of this conversion are still not fully established.
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Affiliation(s)
- Milena Králíčková
- Department of Histology & Embryology, Faculty of Medicine, Charles University, Karlovarska 48, Plzen, Czech Republic
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14
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Kobayashi H, Shigetomi H, Yoshimoto C. Checkpoint kinase 1 inhibitors as targeted molecular agents for clear cell carcinoma of the ovary. Oncol Lett 2015; 10:571-576. [PMID: 26622535 DOI: 10.3892/ol.2015.3268] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/29/2015] [Indexed: 12/12/2022] Open
Abstract
In clear cell carcinoma of the ovary, chemoresistance frequently results in treatment failure. The present study aimed to review the potential association of transcription factor hepatocyte nuclear factor (HNF)-1β with cell cycle checkpoint machinery, as a mechanism for chemoresistance. The English-language literature on the subject was reviewed to identify genomic alterations and aberrant molecular pathways interacting with chemoresistance in clear cell carcinoma. Oxidative stress induced by repeated hemorrhage induces greater susceptibility of endometriotic cells to DNA damage, and subsequent malignant transformation results in endometriosis-associated ovarian cancer. Molecular changes, including those in HNF-1β and checkpoint kinase 1 (Chk1), may be a manifestation of essential alterations in cell cycle regulation, detoxification and chemoresistance in clear cell carcinoma. Chk1 is a critical signal transducer in the cell cycle checkpoint machinery. DNA damage, in turn, increases persistent phosphorylation of Chk1 and induction of G2/M phase cell cycle arrest in cells overexpressing HNF-1β. HNF-1β deletion induces apoptosis, suggesting that enhanced levels of HNF-1β may be associated with chemoresistance. Targeted therapy with Chk1 inhibitors may be explored as a potential treatment modality for patients with clear cell carcinoma. This provides a novel direction for combination therapy, including targeting of Chk1, which may overcome drug resistance and improve treatment efficacy.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Hiroshi Shigetomi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Chiharu Yoshimoto
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara 634-8522, Japan
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15
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Matsuo K, Yoshino K, Hasegawa K, Murakami R, Ikeda Y, Adachi S, Hiramatsu K, Yokoyama T, Nishimura M, Sheridan TB, Enomoto T, Fujiwara K, Matsumura N, Konishi I, Fotopoulou C, Roman LD, Sood AK. Survival outcome of stage I ovarian clear cell carcinoma with lympho-vascular space invasion. Gynecol Oncol 2015; 136:198-204. [DOI: 10.1016/j.ygyno.2014.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 11/27/2014] [Accepted: 12/03/2014] [Indexed: 01/22/2023]
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16
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Aci�n P, Velasco I, Aci�n M, Capello C, Vela P. Epithelial Ovarian Cancers and Endometriosis. Gynecol Obstet Invest 2015; 79:126-35. [DOI: 10.1159/000367597] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/14/2014] [Indexed: 11/19/2022]
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17
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Characteristics of clear cell ovarian cancer arising from endometriosis: A two center cohort study. Gynecol Oncol 2014; 133:480-4. [DOI: 10.1016/j.ygyno.2014.03.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/04/2014] [Accepted: 03/10/2014] [Indexed: 11/23/2022]
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18
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Abstract
Endometriosis is defined as the presence of endometrial-type mucosa outside the uterine cavity. Of the proposed pathogenic theories (retrograde menstruation, coelomic metaplasia and Müllerian remnants), none explain all the different types of endometriosis. According to the most convincing model, the retrograde menstruation hypothesis, endometrial fragments reaching the pelvis via transtubal retrograde flow, implant onto the peritoneum and abdominal organs, proliferate and cause chronic inflammation with formation of adhesions. The number and amount of menstrual flows together with genetic and environmental factors determines the degree of phenotypic expression of the disease. Endometriosis is estrogen-dependent, manifests during reproductive years and is associated with pain and infertility. Dysmenorrhoea, deep dyspareunia, dyschezia and dysuria are the most frequently reported symptoms. Standard diagnosis is carried out by direct visualization and histologic examination of lesions. Pain can be treated by excising peritoneal implants, deep nodules and ovarian cysts, or inducing lesion suppression by abolishing ovulation and menstruation through hormonal manipulation with progestins, oral contraceptives and gonadotropin-releasing hormone agonists. Medical therapy is symptomatic, not cytoreductive; surgery is associated with high recurrence rates. Although lesion eradication is considered a fertility-enhancing procedure, the benefit on reproductive performance is moderate. Assisted reproductive technologies constitute a valid alternative. Endometriosis is associated with a 50% increase in the risk of epithelial ovarian cancer, but preventive interventions are feasible.
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Affiliation(s)
- Paolo Vercellini
- Department of Obstetrics and Gynecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Via Olgettina 60, 20136 Milan, Italy
| | - Edgardo Somigliana
- Department of Obstetrics and Gynecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
| | - Luigi Fedele
- Department of Obstetrics and Gynecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
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19
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Uekuri C, Shigetomi H, Ono S, Sasaki Y, Matsuura M, Kobayashi H. Toward an understanding of the pathophysiology of clear cell carcinoma of the ovary (Review). Oncol Lett 2013; 6:1163-1173. [PMID: 24179489 PMCID: PMC3813717 DOI: 10.3892/ol.2013.1550] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 07/29/2013] [Indexed: 12/12/2022] Open
Abstract
Endometriosis-associated ovarian cancers demonstrate substantial morphological and genetic diversity. The transcription factor, hepatocyte nuclear factor (HNF)-1β, may be one of several key genes involved in the identity of ovarian clear cell carcinoma (CCC). The present study reviews a considerably expanded set of HNF-1β-associated genes and proteins that determine the pathophysiology of CCC. The current literature was reviewed by searching MEDLINE/PubMed. Functional interpretations of gene expression profiling in CCC are provided. Several important CCC-related genes overlap with those known to be regulated by the upregulation of HNF-1β expression, along with a lack of estrogen receptor (ER) expression. Furthermore, the genetic expression pattern in CCC resembles that of the Arias-Stella reaction, decidualization and placentation. HNF-1β regulates a subset of progesterone target genes. HNF-1β may also act as a modulator of female reproduction, playing a role in endometrial regeneration, differentiation, decidualization, glycogen synthesis, detoxification, cell cycle regulation, implantation, uterine receptivity and a successful pregnancy. In conclusion, the present study focused on reviewing the aberrant expression of CCC-specific genes and provided an update on the pathological implications and molecular functions of well-characterized CCC-specific genes.
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Affiliation(s)
- Chiharu Uekuri
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara 634-8522, Japan
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20
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Worley MJ, Welch WR, Berkowitz RS, Ng SW. Endometriosis-associated ovarian cancer: a review of pathogenesis. Int J Mol Sci 2013; 14:5367-79. [PMID: 23466883 PMCID: PMC3634491 DOI: 10.3390/ijms14035367] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/21/2013] [Accepted: 02/26/2013] [Indexed: 12/20/2022] Open
Abstract
Endometriosis is classically defined as the presence of endometrial glands and stroma outside of the endometrial lining and uterine musculature. With an estimated frequency of 5%–10% among women of reproductive age, endometriosis is a common gynecologic disorder. While in itself a benign lesion, endometriosis shares several characteristics with invasive cancer, has been shown to undergo malignant transformation, and has been associated with an increased risk of epithelial ovarian carcinoma (EOC). Numerous epidemiologic studies have shown an increased risk of EOC among women with endometriosis. This is particularly true for women with endometrioid and clear cell ovarian carcinoma. However, the carcinogenic pathways by which endometriosis associated ovarian carcinoma (EAOC) develops remain poorly understood. Current molecular studies have sought to link endometriosis with EAOC through pathways related to oxidative stress, inflammation and hyperestrogenism. In addition, numerous studies have sought to identify an intermediary lesion between endometriosis and EAOC that may allow for the identification of endometriosis at greatest risk for malignant transformation or for the prevention of malignant transformation of this common gynecologic disorder. The objective of the current article is to review the current data regarding the molecular events associated with EAOC development from endometriosis, with a primary focus on malignancies of the endometrioid and clear cell histologic sub-types.
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Affiliation(s)
- Michael J. Worley
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; E-Mails: (M.J.W.J.); (R.S.B.)
| | - William R. Welch
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; E-Mail:
| | - Ross S. Berkowitz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; E-Mails: (M.J.W.J.); (R.S.B.)
| | - Shu-Wing Ng
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; E-Mails: (M.J.W.J.); (R.S.B.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-617-278-0072; Fax: +1-617-975-0856
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