卵巢子宫内膜样癌及其合并子宫内膜异位症的临床及病理分析

目的探讨卵巢子宫内膜样癌及其合并子宫内膜异位症患者的临床、病理特征及预后。方法对中国医科大学第二临床学院和解放军202医院1990年1月至2004年12月40例卵巢子宫内膜样癌患者病理蜡块进行分析,16例为子宫内膜异位症恶变（EM组）,24例为原发卵巢子宫内膜样癌（NEM组）,同期50例原发卵巢浆液性囊腺癌为对照组。比较分析3组一般特征、临床表现、病理特点及预后。结果EM组较NEM组年轻9岁,较对照组年轻5岁,临床主要表现为盆腔包块及下腹胀痛,盆腔包块持续半年以上患者多见。NEM组主要为下腹胀痛及阴道不规则流血。EM组5年存活率为75.0%,NEM组为62.5%。结论子宫内膜异位症恶变患者发病年龄较轻,临床医生要认识子宫内膜异位症恶变为卵巢子宫内膜样癌的临床及病理特点,提高早期诊断率。     

在位子宫内膜及异位子宫内膜同时恶变1例并文献复习

<正>子宫内膜异位症(endometriosis,EM)是育龄妇女的常见病,发病率约15%,临床上以痛经、盆腔痛和不孕为主要表现。EM虽属良性病变,但其表现与恶性肿瘤的生物学行为类似,并有一定比例的异位子宫内膜发生组织学改变,成为癌瘤。EM恶变主要发生在卵巢,病理类型多为子宫内膜样癌或透明细胞癌,卵巢外异位内膜恶变及恶变的其他病理组织学类型较少。现报道1例在位子宫内膜及卵巢外异位内膜同时恶变,并结合文献复习,探讨其临床病理特点、诊断以及治疗。     

卵巢上皮性癌合并卵巢子宫内膜异位症67例临床病理分析

目的 探讨合并卵巢子宫内膜异位症(内异症)的卵巢上皮性癌(卵巢癌)的临床病理特点.方法 选取1996年1月至2006年12月在复旦大学附属妇产科医院就诊并经手术确诊的卵巢癌共727例,对其中合并卵巢内异症的67例患者(其中由卵巢内异症恶变的卵巢癌患者34例,为A组;其他仅合并卵巢内异症的卵巢癌患者33例,为B组)的临床病理资料进行回顾性分析,并与660例未合并卵巢内异症的卵巢癌患者(C组)进行对照分析.同期本院经手术病理确诊的卵巢内异症患者共3890例.结果 卵巢内异症恶变为卵巢癌的发生率为0.87%(34/3890).卵巢癌合并卵巢内异症的发生率为9.2%(67/727).A、B、C组患者的平均年龄分别为(47.2±1.3)、(47.8±1.2)、(51.2±0.4)岁,3组问比较,差异有统计学意义(P=0.013).A、B组病理类型多为透明细胞癌(分别为67.6%、69.7%),其所占比例均明显高于C组的18.8%(P=0.000);而C组以浆液性腺癌(50.3%)为主,其所占比例明显高于A组的8.8%和B组的12.1%(P=0.000).A、B组手术病理分期多为Ⅰ期(分别为73.5%、63.6%),其所占比例均明显高于C组的31.4%(P=0.000);而C组多为Ⅲ期(47.7%),其所占比例明显高于A组的23.5%和B组的15.2%(P=0.001).A、B、C组高分化(分别为11.8%、6.1%、10.5%)、中～低分化(分别为88.2%、93.9%、89.5%)所占比例分别比较,差异均无统计学意义(P=0.602).A、B、C组雌激素受体(ER)阳性率分别为22.2%(6/27)、31.6%(6/19)、43.9%(136/310),3组间比较,差异有统计学意义(P=0.018);A、B、C组孕激素受体(PR)阳性率分别为22.2%(6/27)、15.8%(3/19)、35.5%(110/310),3组间比较,差异无统计学意义(P=0.082).患者总的5年累积生存率为55.6%,A、B、C组患者的5年累积生存率分别为78.9%、92.8%、51.9%,3组间比较,差异有统计学意义(P=0.000).结论 合并卵巢内异症的卵巢癌患者,具有年轻(尤其是内异症恶变患者)、多为卵巢透明细胞癌、期别早、ER表达水平低、预后好的特点.     

卵巢子宫内膜异位症恶变与卵巢癌的相关性研究及预后分析

目的:探讨不同原因所致卵巢癌,尤其是是否由卵巢子宫内膜异位症(EMT)恶变而来的卵巢癌的临床病理及预后特征。方法:纳入2006年1月至2011年8月在四川大学华西第二医院病理检查确诊的有随访资料(术后随访时间2~89月)的EMT恶变者所致原发性卵巢癌患者49例为EMT恶变组,其病理类型为透明细胞癌、子宫内膜样腺癌及混合性腺癌;另选择非EMT恶变所致卵巢癌并与EMT恶变者具有相同组织学类型的卵巢癌患者188例为非EMT恶变组,比较两组卵巢癌的临床病理特征及预后特征。结果:1与非EMT恶变组比较,EMT恶变组在40岁人群中所占比例较大、CA125更多表现为正常而非升高、FIGO分期早期病例比例更多、透明细胞癌及子宫内膜样腺癌这两种病理类型的比例较高,两组差异有统计学意义(P0.05)。2单因素预后分析:EMT恶变所致透明细胞癌的生存率明显高于非EMT恶变所致透明细胞癌(P=0.010),是否由EMT恶变对子宫内膜样腺癌及混合性腺癌的预后影响不确切(P0.05)。3多因素COX回归分析:EMT恶变、手术满意度及FIGO分期是影响预后的独立危险因素。结论:EMT恶变所致卵巢癌病理类型主要包括透明细胞癌和子宫内膜样腺癌,EMT恶变是卵巢癌预后的独立影响因素,EMT恶变患者年龄相对较年轻、FIGO分期相对较早,尤其对透明细胞癌而言,EMT恶变的患者可能拥有更好的预后。     

卵巢透明细胞癌合并盆腔子宫内膜异位的预后:临床病理评估

卵巢透明细胞癌常合并盆腔子宫内膜异位症(EM),为评价卵巢透明细胞癌与盆腔子宫内膜异位之间临床病理的相关性,对1984～1995年间Keio大学医院妇产科收治首次治疗的原发性卵巢癌日本患者325例,其中卵巢透明细胞癌53例平均年龄51,1(39～76)岁。所有患者首次手术时均行卵巢癌细胞减灭术,残留肿瘤大小均小于2cm。术后除2例外均接受含顺铂的联合化疗。本研究中,合并盆腔子宫内膜异位的卵巢透明细胞癌指:①同一卵巢组织病理证实同时存在卵巢透明细胞癌及异位的子宫内     

卵巢子宫内膜异位症恶变的临床病理特征分析

目的:分析卵巢子宫内膜异位症(EMs)恶变的临床病理特征。方法:回顾分析2011年12月至2015年12月于郑州大学人民医院妇科行手术治疗且术后病理确诊的卵巢癌患者281例,其中符合内异症恶变诊断标准者24例(内异症恶变组),非内异症恶变者257例(非内异症恶变组)。分析两组患者的临床组织病理学类型及FIGO分期。结果:与非内异症恶变组相比,内异症恶变组患者的平均年龄早、绝经前诊断比例较大,差异均有统计学意义(P0.05)。内异症恶变组术前CA125值(110.27±112.62)U/ml,腹水量较少、病理类型多为透明细胞癌(45.83%)、FIGO分期早期(87.50%);非内异症恶变组术前CA125值(1242.75±2104.28)U/ml、腹水量较多,病理类型多为浆液性腺癌(72.37%),FIGO分期晚期(74.71%);两组比较,差异均有统计学意义(P均0.05)。两组患者在癌灶单双侧及淋巴结转移情况比较,差异均无统计学意义(P均0.05)。结论:卵巢内异症恶变患者发病年龄小、腹水量少、术前CA125较低、FIGO期别早,组织病理以透明细胞癌及子宫内膜样腺癌为主。     

卵巢子宫内膜异位症恶变25例临床病理及预后分析

目的:探讨卵巢子宫内膜异位症(EMs)恶变患者的临床病理特征及预后。方法:回顾分析2005年6月至2014年6月经病理确诊的原发性卵巢恶性肿瘤患者190例,其中卵巢EMs恶变25例(EAOC组),未合并卵巢EMs的卵巢癌165例(NEAOC组)。比较两组患者的临床病理及预后特征。结果:EAOC组和NEAOC组患者的年龄、首发症状、术前CA125水平比较,差异有统计学意义(P0.05);肿块直径和卵巢癌侧别比较,差异无统计学意义(P0.05)。EAOC组的FIGO分期期别相对较早,病理类型以透明细胞癌及子宫内膜样腺癌居多。EAOC组较NEAOC组的中位PFS时间长,中位OS时间短,差异均有统计学意义(P0.05)。结论:EAOC发病年龄早,CA125水平轻度升高,FIGO分期期别较早,病理类型主要为透明细胞癌和子宫内膜样腺癌,无进展生存期较优,但远期生存期较差。     

卵巢子宫内膜异位症恶性变25例临床分析

目的 探讨卵巢子宫内膜异位症恶性变的临床表现、病理特征、治疗方法和预后。方法 回顾性分析２５例卵巢子宫内膜异位症恶性变患者和病量资料。结果 卵巢子宫内膜异位症恶性变患者的主要症状为盆腔包块、腹胀、腹痛、异常阴道流血和流液。病理类型为子宫内膜样癌１４例,透明细胞癌２例,腺棘癌２例,浆液性腺癌１例,混合性卵巢上皮性癌６例,镜下均可见良性的异位子宫内膜向恶性移行的证据。临床分期为Ⅰ１４例,Ⅱ期７例,Ⅲ期３例,Ⅳ期１例。治疗方法均采用肿瘤细胞减灭术＋化学治疗。患者５年生存率达７７．７％。结论 卵巢子宫内膜异位症恶性变的确切发生率难以估计,该病的治疗以肿瘤细胞减灭术＋化学治疗为主。     

卵巢透明细胞癌70例临床分析

目的:探讨卵巢透明细胞癌的临床特点、预后及与子宫内膜异位症的关系.方法:对70例原发性卵巢透明细胞癌患者回顾性分析其治疗方法、对化疗的敏感性和生存率,以及合并子宫内膜异位症患者对化疗的敏感性和生存率.结果:根据FIGO分期,70例中工期44例,Ⅱ期13例、Ⅲ期13例.70例总的5年生存率为48.97%.患者全部进行手术,其中满意肿瘤细胞减灭术62例,占88.6%(62/70);不满意肿瘤细胞减灭术8例,占11.4%(8/70).两组5年生存率分别为61.52%和7.69%(P＜0.05).术后5例放弃化疗,65例于术后1～2周内进行了以PT、PAC等共3至8个疗程化疗.是否合并子宫内膜异位症对化疗的敏感性和生存率无统计学差异.结论:卵巢透明细胞癌临床特点不同于其他的卵巢上皮性恶性肿瘤,其临床分期早,化疗不敏感,易复发,预后差.伴有子宫内膜异位症与否与预后无相关性.     

卵巢癌合并子宫内膜异位症病例分析

目的分析卵巢癌病例中子宫内膜异位症的发生情况及其相互关系。方法 对210例原发性卵巢恶性肿瘤中合并有子宫内膜异位症的患者进行回顾性分析。结果 原发性卵巢恶性肿瘤合并子宫内膜异位症25例，发生率为11．9％，其中内膜样癌12例，透明细胞癌6例，黏液性4例，浆液性2例，其他类型1例。结论子宫内膜异位症与卵巢内膜样癌和透明细胞癌关系密切，内膜异位症病灶恶变可能是这两型卵巢癌的来源之一。     

Prognosis of Japanese patients with ovarian clear cell carcinoma associated with pelvic endometriosis: clinicopathologic evaluation

OBJECTIVE: Ovarian clear cell carcinoma is commonly associated with pelvic endometriosis. We retrospectively evaluated clinicopathological data on the association between ovarian clear cell carcinoma and pelvic endometriosis. METHODS: Between 1984 and 1995, we evaluated clinicopathological data on 53 Japanese patients with primary ovarian clear cell carcinoma who had been initially treated at Keio University Hospital. The clinical backgrounds and 5-year survival rates were evaluated. RESULTS: Twenty (37.7%) of the 53 patients had carcinoma accompanied by pelvic endometriosis. These 20 cases were classified as FIGO stage I (n = 13, 65%), stage II (n = 1, 5%), stage III (n = 6, 30%), or stage IV (n = 0). The other 33 cases of ovarian clear cell carcinoma had no evidence of association with endometriosis and were classified as stage I (n = 19, 57.6%), stage II (n = 2, 6.1%), stage III (n = 9, 27.2%), or stage IV (n = 3, 9.1%). The incidence of a positive intraperitoneal cytology in stage Ic was significantly less in the group with endometriosis than in that without the endometriosis (n = 1, 14.3% vs n = 9, 64.3%, P = 0.03). The 5-year survival rate of stage I patients was significantly greater in ovarian clear cell carcinoma with pelvic endometriosis (100%) than in that without it (60%, P < 0.05). CONCLUSION: Patients having ovarian clear cell carcinoma with pelvic endometriosis exhibited a better prognosis than those without endometriosis, especially those patients with stage I cancer.     

Ovarian carcinoma associated with endometriosis

Objectives

Previous studies have suggested an association between endometriosis and development of ovarian cancer. A study was performed to evaluate the cases of ovarian carcinoma associated with endometriosis.

Study design

The study includes patients with ovarian carcinoma associated with endometriosis diagnosed between 2000 and 2010 at Hacettepe University Hospital, Ankara, Turkey. A total of 1086 patients who underwent surgical staging for ovarian carcinoma were analyzed retrospectively for the presence of histologically documented endometriosis. The clinical and pathological characteristics of 45 ovarian carcinoma patients associated with endometriosis were evaluated including histologic subtype, stage and grade.

Results

Ovarian carcinoma was found to be associated with endometriosis in 4.1% (45/1086) of the cases. Of them, 17 patients (37.8%) had clear cell, 15 (33.3%) had endometrioid, 6 (13.3%) had serous papillary, 4 (8.9%) had mucinous and the remaining 3 patients had an undifferentiated subtype of ovarian carcinoma. Twenty-three (51.1%) patients had stage I, 4 (8.9%) had stage II and 18 (40.0%) had stage III disease. The frequency of coexistence of endometriosis was 20.4% (17/83) for clear cell carcinoma and 9.3% (15/161) for endometrioid cell carcinoma.

Conclusions

Only a small proportion of ovarian cancer cases were found to be associated with endometriosis. Endometriosis was most frequently associated with clear cell and endometrioid types of ovarian carcinoma. Ovarian carcinoma associated with endometriosis seems to represent a distinct disease entity with different histological subtypes, early presentation and a relatively favorable outcome.     

Endometrioid carcinoma arising in endometriosis. Case report.

Malignant transformation arising in endometriosis has been reported in some cases. Following Sampson's criteria, about 0.7%-1% of all cases of endometriosis undergo malignant transformation and the ovary is the most frequent site. A case is reported of a patient with endometriosis which, after 10 years, grew into ovarian endometrioid carcinoma. The relationship between endometriosis and cancer suggests a radical treatment of endometriosis and a careful assessment of postmenopausal woman presenting reactivation signs.     

A clinicopathologic study on the association of endometriosis and carcinoma of the ovary using a scoring system

Two-hundred and thirty-five cases of epithelial ovarian carcinoma were studied with a newly devised scoring system for endometriosis consisting of both clinical and histopathologic findings, in order to evaluate the association with endometriosis. Fifty cases (21.3%) of all carcinomas evaluated were judged to be associated with endometriosis. The patients with endometriosis were younger and their clinical stage was significantly earlier than those without endometriosis. The predominant histologic subtype was clear cell carcinoma and the histologic grade was mostly 1 or 2 in the tumors with endometriosis. No prognostic difference was noted between the cases associated with endometriosis and those without endometriosis in stage 1 and 2 disease. In conclusion, the actual frequency of the association of endometriosis with ovarian carcinoma is higher than supposed and almost half of clear cell carcinomas are definitely related to endometriosis, and the cases of ovarian carcinoma associated with endometriosis occur in younger patients, and are of earlier stage and lower histologic grade, but the association of endometriosis does not seem to otherwise influence prognosis.     

The ultrastructure of endometrioid carcinomas of the ovary

Endometrioid carcinoma is an epithelial cancer of the ovary which histologically resembles adenocarcinoma of the endometrium, accounts for 15–20% of ovarian cancers [11], and is generally considered to have a relatively favorable outcome [5,6]. Sampson in 1925 first described the relationship of these tumors to endometriosis and suggested that they might originate from foci of endometriosis [1]. In spite of various published reports of malignant transformation of ovarian endometriosis in the literature [2–4], it is not always possible to demonstrate the transition between a benign cyst and true malignancy. However, in an alternate theory of histogenesis, it has been postulated that endometrioid tumors arise metaplastically from celomic epithelial inclusion cysts and should be classified in the cystoma group. In order to examine further the histogenesis of these lesions, we have undertaken a fine structural study of 12 cases of endometrioid carcinoma of the ovary.     

Ovarian endometriosis associated with ovarian cancer and endometrial-endocervical polyps

AIM: To determine the prevalence of ovarian cancer and endometrial polyps in women with moderate and severe ovarian endometriosis. METHODS: A retrospective analysis of 667 cases of moderate and severe endometriosis laparoscopically and histologically confirmed during the period 1997-2004. RESULTS: One hundred and ninety-three (29%) of cases were American Fertility Society (AFS) stage III (moderate endometriosis) and 473 (71%) were AFS stage IV (severe endometriosis). Ovarian cancer was diagnosed in 13 cases (2.0%), while an endometrial or endocervical polyp was identified in 35 cases (5.3%). The incidence of endometrial polyps in the group with moderate endometriosis tended to be higher (15/193, 7.8%) than in the group with severe endometriosis (20/473, 4.2%), and the same results were obtained in the ovarian cancer group (moderate: 6/193, 3.1%; severe: 7/473, 1.5%). However, neither of the two differences was statistically significant. CONCLUSIONS: Ovarian endometriosis may be associated with an increased incidence of both ovarian cancer and endometrial polyps. Careful evaluation for coexistent pathology should be undertaken in women with symptomatic endometriosis.     

Evidence that endometriosis behaves in a malignant manner

It is well known that certain aspects of endometriosis are similar to those of malignant disease. For example, like cancer, endometriosis can be both locally and distantly metastatic; it attaches to other tissues, invades, and damages them. Endometriosis is a common disease that does not create a cachectic or catabolic state, and is rarely fatal. There are, however, numerous reported cases of malignancy arising from endometriotic deposits and substantial histologic evidence that endometriosis is associated with endometrioid carcinoma and clear cell carcinoma of the ovary. A large review article by Mostoufizadeh and Scully investigated the association between endometriosis and endometrioid carcinoma, noting that women who had both diseases tended to be younger [1]. They found no association between endometriosis and serous or mucinous carcinoma of the ovary, and reported that malignant transformation of endometriosis was rare and associated with the use of exogenous estrogens. An epidemiological study of Swedish women reported a higher incidence of breast and ovarian cancer and non-Hodgkin's lymphoma in women with endometriosis compared with controls [2]. Vercellini and colleagues also reported a higher incidence of endometrioid and clear cell carcinoma in women with endometriosis compared with controls [3]. Mutations in genes associated with galactose metabolism have been identified as one possible mechanism for this association. These mutations are more common in ovarian cancer and have been reported to be more common in women with endometriosis. We compared 78 women with endometriosis with 248 controls and were unable to demonstrate an increased frequency of these mutations in any of these groups.     

Simultaneous appearance of ovarian and endometrial carcinoma: a therapeutic challenge

We have analyzed 37 cases of simultaneous appearance of carcinoma in the ovary and endometrium. This paper deals with the question of whether they should be considered stage III endometrial carcinomas, stage II ovarian carcinomas or independent primary tumors. The cases were grouped according to their histology as endometrioid ovarian carcinomas with endometrial carcinoma (group A), same carcinoma, but not of endometrial origin in both organs (group B) and histologically different concomitant carcinomas of ovary and endometrium (group C). Although our series was small, the survival was better than could have been expected either for stage III endometrial carcinoma, or stage II ovarian carcinoma. This supports the view that many of those tumors should be considered independent stage I carcinomas. Another fact in favour of this hypothesis is the strong correlation between myometrial invasion and prognosis in these cases, which is comparable to that found in endometrial carcinoma alone.