Ovarian Endometrioid and Clear Cell Carcinoma Arise Via Different Precursor Lesions and Have Better Prognosis When Associated with Endometriosis
J Cuff, TA Longacre. Stanford University, Stanford, CA
Background: Ovarian clear cell carcinoma (CCC) and endometrioid carcinoma (ECC) often develop in association with endometriosis, yet they are considered to have significantly different clinical behavior. To identify distinctive features that may play a role in the differing biology of these tumors, we evaluated a series of CCC and ECC from the files of Stanford University.
Design: 60 CCC and 61 ECC were analyzed for the presence of associated ovarian/pelvic endometriosis, ovarian/pelvic adenofibroma, and synchronous uterine endometrial hyperplasia (U-EH) or endometrioid carcinoma (U-ECA). Tumors were classified on the basis of standard criteria; specifically, ECC required rounded gland contours and/or squamous differentiation. Results were correlated with patient age, FIGO stage, presence of bilateral ovarian disease, and follow up, when available.
Results: Endometriosis was significantly more common in association with ovarian CCC than ECC (p<0.0001), while synchronous endometrioid tumors were more common in association with ovarian ECC (p<0.0001). Bilateral ovarian involvement in CCC, when present, typically exhibited a metastatic pattern and only occurred in the setting of high stage disease. However, 18% of ECC were bilateral and 73% occurred in the setting of low stage disease (FIGO IB).
Endo=endometriosis; Adfib=adenofibroma; U-EH=uterine endometrial hyperplasia; U-ECA=uterine ednometrioid carcinoma; NED=no evidence of disease; AWD=alive with disease; DOD=dead of disease
Conclusions: Of the observed clinicopathologic features, none contributed significantly to FIGO stage or survival in either CCC or ECC. CCC predominantly arise in association with ovarian/pelvic endometriosis, while ECC arise in the setting of synchronous endometrial carcinoma or adenofibroma. When strictly defined, most ECC are low stage and clinically benign. This data suggests a field defect in ovarian tumors with endometrioid histology, while no such defect appears to be operative in ovarian CCC.
Monday, March 9, 2009 2:00 PM
Platform Session: Section C, Monday Afternoon