子宫内膜异位症相关恶变的研究近况

子宫内膜异位症是一类常见的妇科疾病,其发病率为6%～10%。虽然为良性疾病,但有恶变风险,卵巢子宫内膜异位囊肿恶变率约为1%。目前关于子宫内膜异位症相关恶变的病因及发病机制尚不清楚。许多研究提示了子宫内膜异位症与恶性肿瘤密切相关,并认为子宫内膜异位症是卵巢癌的高危因素。流行病学研究显示,初诊年龄大、囊肿直径大、不孕及肥胖等会增加其恶变风险,生育次数多、子宫内膜异位病灶清除术、患侧附件切除术以及长期服用避孕药等可降低此风险。基础研究显示,氧化应激与抗氧化防御、炎症反应、激素作用、环境因素及基因突变等因素与其恶变机制关系密切。此文主要对子宫内膜异位症相关恶变的发病风险、高危因素、保护因素和发病机制4方面的进展进行归纳与总结,有助于进一步了解该疾病。     

卵巢子宫内膜异位癌恶变预测方法研究

目的:寻求预测子宫内膜异位症(EMs)相关卵巢癌恶变的方法。方法:采用病例-对照研究的方法,以21例卵巢子宫内膜异位症恶变患者为病例组,以45例卵巢内膜样囊肿患者为对照组,分析卵巢子宫内膜异位症恶变患者的病史特点、血清CA125水平、超声学改变。结果:病例组中囊壁见乳头或血流丰富者显示多于对照组,组间差异有统计学意义(P0.05);囊肿直径8 cm的恶变风险OR=8.7(95%CI=2.6~29.3,P0.001);CA125200 IU/ml的恶变风险OR=2.3,但差异无统计学意义(95%CI=0.4~12.7,P=0.33);病程5年的恶变风险OR=1.3(95%CI=0.4~4.3,P=0.72),囊肿超声见分隔或囊肿周围粘连在病例组和对照组中差异无统计学意义(P0.05)。结论:囊壁有乳头或囊壁见血流、囊肿直径8 cm为恶变的高危因素;CA125200 IU/ml、病程5年可能是恶变的高危因素,但不能有效预测恶变的发生。     

巨大腹壁子宫内膜异位症恶变一例并文献复习

子宫内膜异位症（endometriosis,EMs）是一种育龄期妇女常见的良性疾病,多发生在子宫和卵巢。腹壁子宫内膜异位症（abdominal wall endometriosis,AWE）是指具有生长功能的子宫内膜组织异位到腹壁而形成的异位子宫内膜病灶。少部分EMs可向恶性转化,约80%的EMs相关恶性肿瘤局限于卵巢,而20%发现于性腺外部位,其中AWE恶变的病例较罕见。报告1例肿瘤体积较大的AWE恶变病例并进行文献复习,总结该病的临床特征、发病机制等,以期早期诊断和治疗AWE恶变患者,延长其生存时间。     

输尿管子宫内膜异位症恶变为中分化子宫内膜样癌1例

输尿管子宫内膜癌罕见, 考虑其由异位到输尿管的子宫内膜发生恶变形成, 而异位子宫内膜恶变的发生率仅为1%左右。本文通过分析广西壮族自治区人民医院2021年收治的1例输尿管子宫内膜异位症恶变为中分化子宫内膜样癌患者的诊疗过程, 并复习相关文献资料, 进一步探讨本病的临床症状、诊断方法、治疗方案及结局。     

子宫内膜异位症相关性卵巢癌研究进展

子宫内膜异位症相关性卵巢癌(EAOC)是指组织学上与子宫内膜异位症(EMs)密切相关,并可能由EMs恶变而来,以卵巢透明细胞癌及卵巢内膜样癌为主要病理类型的一类上皮性卵巢癌。EAOC的发病机制尚未阐明,但研究显示,EMs尤其是非典型子宫内膜异位症(aEM)与EAOC有共同分子遗传学改变,提示以上病变共享相同的分子致病途径。本文基于国内外临床及基础研究,重点针对EAOC的发病机制、EMs恶变生物学标志物及其易感人群筛查方法的研究进展做以总结,并对其研究方向进行展望。     

子宫腺肌病恶变

子宫腺肌病(adenomyosis)是指子宫内膜腺体及间质侵入子宫肌层,周围平滑肌呈不同程度增生的一种良性病变,是一种发生在子宫肌壁内的特殊的子宫内膜异位症。多与盆腔子宫内膜异位症同时发生,其表现与恶性肿瘤的生物学行为类似,并且有一定比例的异位子宫内膜发生组织学改变,成为癌瘤。1发病率1925年,Sampson首次报道了卵巢子宫内膜异位症恶性变的病例,随后国内外相关报道相继出现。子宫内膜异位症恶变率,国内报道为1.5%,国外报道为0.7%~1.0%。子宫内膜异位症恶变最常见的组织学类型为卵巢子宫内膜样癌,约占69.1%,包括性腺外病灶的恶变,其次为…     

子宫内膜异位症复发机制及相关因素的研究进展

子宫内膜异位症（EMs）是育龄妇女常见病,其复发率高,许多学者开始探讨研究子宫内膜异位症复发的机制。近年来研究结果显示,经血逆流、激素依赖及免疫因素等方面在子宫内膜异位症复发机制中发挥一定作用;同时流行病学研究也发现生殖状况、囊肿特征、临床分期以及辅助药物治疗等临床因素与子宫内膜异位症复发相关。目前主要采用手术联合相关辅助治疗手段改善子宫内膜异位症的预后,降低复发率。     

子宫内膜异位症的病因学和流行病学

子宫内膜异位症已被列为二十世纪的疾病而受到重视,其发病率较前增加,约占所有生殖年龄妇女的5～20%,占不孕症妇女20％以上。从病因学及流行病学观点来看,有相当一部分病例是可以预防其发生的。一、年龄因素:子宫内膜异位症在初潮前无发病者,青春期发病罕见,性成熟期为好发年龄,妊娠期能阻止疾病进展,绝经后异位内膜多逐渐萎缩吸收,说明此症的发生与卵巢功能相关,异位子宫内膜的生长主要依赖雌激素的存在。动物实验证明,去势猴子     

子宫内膜异位症的恶变

子宫内膜异位症的分子生物学研究已成为当今研究的热点,子宫内膜异位症为良性病变,但具有与恶性病变类似的浸润、转移和复发等分子生物学特征。现将有关子宫内膜异位症的恶变及相关问题作一综述。子宫内膜异位症恶变涉及不典型子宫内膜异位症、卵巢癌、基因异常、细胞凋亡、细胞的单克隆起源及二恶英等因素,故认为子宫内膜异位症可能是卵巢癌的癌前病变。     

子宫内膜异位症复发机制及相关因素的研究进展

子宫内膜异位症(EMs)是育龄妇女常见病,其复发率高,许多学者开始探讨研究子宫内膜异位症复发的机制.近年来研究结果显示,经血逆流、激素依赖及免疫因素等方面在子宫内膜异位症复发机制中发挥一定作用;同时流行病学研究也发现生殖状况、囊肿特征、临床分期以及辅助药物治疗等临床因素与子宫内膜异位症复发相关.目前主要采用手术联合相关辅助治疗手段改善子宫内膜异位症的预后,降低复发率.     

子宫内膜异位症与卵巢癌关系的研究进展

子宫内膜异位症(endometriosis,EMs)是一种良性妇科疾病,但具有恶性行为。流行病学及病理学等研究证实EMs可增加卵巢癌,尤其是透明细胞癌和子宫内膜样癌的风险。近年国内外关于EMs相关卵巢癌(endometriosis associated ovarian cancer,EAOC)的报道不断增加,已证实这是一类特定类型的卵巢癌,EAOC的病因、发病机制和临床特点的研究已成为热点。通过阅读大量文献,分析目前报道的EAOC的危险因素、发病机制、临床特点及诊断方法,以提高对该病的认识。     

Malignome auf dem Boden einer Endometriose

Potentially malignant tumors can arise from endometriosis. This malignant transformation can basically affect every tissue that harbors endometriosis. A direct carcinogenic transformation of benign endometriosis via atypia seems to be possible. Histologically, endometriosis-associated malignancies mostly present as clear-cell and endometrioid carcinomas and also rarely as other histological types. The overall risk of malignant transformation of endometriosis tissue has been estimated in older studies as 1?% and for ovarian endometriomas 2.5?% with a range between 2?% and 17?%. Mutations in the phosphatase and tensin homolog (PTEN) and AT rich interactive domain 1A (ARID1A) genes as well as loss of heterozygosity have been reported as molecular biological findings. In the case of ovarian manifestation a more favorable prognosis has been discussed for these tumors compared to high-grade serous ovarian carcinomas. The Endometriosis Research Foundation (SEF) and the working group gynecological oncology (AGO) are currently conducting a joint retrospective study to characterize these endometriosis-associated tumors including an expert histopathological second opinion in a reference laboratory.     

Endometriosis and malignoma

Malignant tumors arising from endometriosis are rare. A frequency of about 1% has been reported with in 80% the ovary, and in 20% extragonadal sites being affected. The most common extragonadal manifestations are the rectosigmoid and the rectovaginal septum. For extragonadal malignant tumors arising from endometriosis, complete resection followed by post-operative radiotherapy, possibly plus adjuvant progestin therapy, is the treatment of choice. Endometriosis-associated ovarian carcinomas are likely to present with lower stage disease and predominantly lower grade tumors. While their treatment follows that of common ovarian cancer, a poorer response to chemotherapy must be considered. As unopposed estrogen replacement therapy has been identified as a risk factor for the development of endometriosis-associated cancer, it is not recommended for hormone replacement therapy in women with a history of endometriosis. Loss of heterozygosity and mutations of the PTEN tumor suppressor gene may be early events of tumorigenesis. Endometriosis and its malignant transformation, perhaps, may serve as a suitable model in this regard. According to recent studies, endometriosis is associated with an increased relative risk of non-Hodgkin lymphoma.     

Endometriosis and the development of malignant tumours of the pelvis. A review of literature

For several decades, endometriosis has been suspected of playing a role in the aetiology of ovarian cancer. The literature concerning a possible histogenesis of ovarian cancer from benign endometriosis is reviewed in this chapter. Epidemiological evidence from large-cohort studies confirms endometriosis as an independent risk factor for ovarian cancer. Further circumstantial evidence for this link was found in the common risk factors for ovarian cancer and endometriosis. These risk factors influence retrograde menstruation and endometriosis in the same positive or negative way. Based on data in the literature, the prevalence of endometriosis in epithelial ovarian cancer has been calculated to be 4.5, 1.4, 35.9, and 19.0% for serous, mucinous, clear-cell and endometrioid ovarian carcinoma, respectively. The risk of malignant transformation in ovarian endometriosis was calculated at 2.5% but this might be an underestimate. In addition, some authors described atypical endometriosis in a spatial and chronological association with ovarian cancer. Finally, molecular studies have detected common alterations in endometriosis and ovarian cancer. These data suggest that some tumours, especially endometrioid and clear-cell carcinomas, can arise from endometriosis. Moreover, endometriosis-associated ovarian cancer represents a distinct clinical entity, with a more favourable biological behaviour, given a lower stage distribution and better survival than non-endometriosis-associated ovarian cancer.     

卵巢子宫内膜异位症与卵巢恶性肿瘤的相关性分析

目的卵巢子宫内膜异位症（EM）是常见的妇科良性疾病,具有潜在的恶变可能。本研究通过对卵巢EM恶变、合并EM及未合并EM的卵巢恶性肿瘤病例的分析,了解卵巢EM恶变与卵巢恶性肿瘤的关系。方法 回顾性分析新疆医科大学第一附属医院2003年1月至2010年12月经病理确诊的原发性卵巢恶性肿瘤患者共362例,根据卵巢EM恶变诊断标准及病理结果,将EM恶变的17例患者分为A组,其他仅合并卵巢EM的卵巢恶性肿瘤16例患者分为B组,未合并卵巢EM的卵巢恶性肿瘤329例为C组,从卵巢恶性肿瘤的临床病理资料对三组进行对照分析。同期在本院经手术确诊的卵巢EM患者共1 946例。结果A、B组临床症状多以腹痛为主,其次为盆腔包块;从临床分期来看,A、B组以Ⅱ期居多,分别占70.6%、56.5%,C组以Ⅲ期为多,占47.7%;从组织类型来看,A、B组多为透明细胞癌（分别为70.6%、56.2%）,而C组则以浆液性腺癌（50.2%）为主。三组在一般特征、临床分期及病理组织分类的分布差异均有统计学意义。结论卵巢EM恶变的临床症状以腹痛为多,其次为盆腔包块,肿块直径超过9 cm,且CA125水平多在200 U/ml以上;卵巢EM恶变及卵巢恶性肿瘤合并EM病例中早期患者比例较高,具有年轻化（尤其是卵巢内异症恶变患者）的特点,且多为卵巢透明细胞癌和子宫内膜样癌;卵巢EM恶变的诊断与组织病灶程度、临床分期可能有关,卵巢EM病灶恶变可能来源于透明细胞癌和子宫内膜样癌,因此卵巢EM可被认为是卵巢恶性肿瘤的危险因素。     

Endometrial carcinoma using GnRH analogues therapy in endometriosis

Endometriosis affects a 10 % of women during their reproductive years. Unequoral statistics concerning the incidence of adenomyosis are not available although a combined occurrence of both diseases is found in a 20 % of cases. The risk that malignancy arises from endometrioid tissue typical for endometriosis is between a 0.3-1 %. 75 % of these malignancies are ovarian cancer in conjunction with pre-existing ovarian endometriosis; less frequently extraovarian malignancies are found. The development of malignancy of adenomyosis is very rarely reported. In this report we present the case of a 35 year old patient who suffered from both, endometriosis and adenomyosis and who underwent a therapy using GnRH analogues. After five months and before the completion of the therapy a hysterectomy with conservation of the ovaries was performed at the request of the patient (carcinophobia). The histology confirmed the diagnosis of adenomyosis and demonstrated the unexpected finding of an endometrium carcinoma. This latter arose from a complex atypical hyperplasia surrounded by hypoplastic endometrium. There is some evidence that suggests a slightly elevated risk of breast and ovarian cancer as well as haematological malignancies amongst patients with endometriosis. However, there does not appear to be an increased risk of endometrial carcinoma. Adipositas leads to an increased risk for the development of endometrial carcinoma due to the increased conversion of testosterone to estrone in fat. The peripheral synthesis of estrone is unaffected by GnRHa-therapy. A progesterone containing HRT should be added to a GnRHa-therapy in overweight patients to prevent the development of endometrial hyperplasia and/or carcinoma. In conclusion a careful indication has to be made for GnRHa-therapy in overweight patients and before and during the therapy high resolution ultrasound scan should be performed to evaluate the endometrium in those patients.     

Malignant transformation of ovarian endometriosis

One hundred forty-seven cases of ovarian endometriosis, encountered from 1976 to 1999 at Tsukuba University Hospital, were studied to clarify the incidence of malignant transformation. There were 18 cases (12.2%) of atypical endometriosis, among which we found a case (5.6%) of ovarian cancer arising from endometriosis not diagnosed before surgery. This is accounted for 0.7% of all ovarian endometriosis cases. Because the incidence was equal to that of the previous reports, it is most likely that the malignant change in ovarian endometriosis occurred in 0.7% of this disease.     

围绝经期子宫内膜异位症及其恶变问题

相较于绝经前子宫内膜异位症(简称内异症),由于发生率的降低,围绝经期和绝经后内异症往往更易被忽视.绝经后内异症的恶变潜能目前已被广泛认可并取得临床证据支持.内异症恶变多数发生在卵巢,少数为卵巢外的内异症相关癌.内异症相关卵巢癌(EAOC)具有其特殊的发病机制及临床特征,但其治疗方案仍然遵循普通上皮性卵巢癌治疗原则.近年...     

血小板及相关因子功能的异常与子宫内膜异位症发病机制的关系

子宫内膜异位症是妇科的常见病及多发病,其是一种良性的慢性疾病,影响着10%～15%的育龄女性,其症状主要表现为痛经、盆腔粘连及不孕,其发病机制已有许多的假说但尚未认识清楚。近年来国内外学者相继发现血小板在子宫内膜异位症发病中具有重要的作用,主要表现子宫内膜异位症患者的血小板黏附、聚集功能存在缺陷,子宫内膜异位症患者的血小板计数升高,其血液处于相对高凝状态,并能介导炎症反应,血小板相关因子如P-选择素、CD40L、血小板生长因子在子宫内膜异位症的发病中起到不同程度的促进作用,而且血小板能够影响子宫内膜异位症患者体内的雌激素及其受体的表达,因此综述血小板功能上的异常与子宫内膜异位症的发病机制之间可能存在的联系,为临床上应用血小板来诊治子宫内膜异位症提供理论依据。