Ovarian Atypical Endometriosis: A Precancerous Lesion
Masaharu Fukunaga. Jikei University Daisan Hospital, Tokyo, Japan
Background: Endometriosis is a relatively common condition found in up to approximately 30% of women undergoing laparotomy. But little is known about the incidence of ovarian atypical endometriosis (AEM) and its relation to ovarian carcinomas and the precancerous potential has been discussed.
Design: A series of consecutive cases coded as ovarian endometriosis (EM), ovarian carcinoma, or borderline tumor during the period 1987 to 2009 was retrieved from the surgical pathology files at our hospitals and was clinicopathologically analyzed. The diagnosis of AEM was based on the presence of epithelial features: large hyperchromatic or pale nuclei with moderate to marked pleomorphism; increased nuclear to cytoplasmic ratio; and cellular crowding, stratification, or tufting. Three or more of these criteria must be present.
Results: Atypical glandular changes without ovarian epithelial tumor were observed in 7 (1.1%) of 624 ovarian EM cases. The changes were always focal findings. One patient with ovarian AEM had synchronously endometrioid carcinoma and AEM in the subserosal of the uterus. One patient with ovarian AEM developed endometrioid carcinoma in the abdominal wall 18 months after left oophorectomy. The remaining five ovarian AEM patients without ovarian neoplasm did not develop any malignant epithelial tumors in a follow-up study with average of 6.2 years and a range of 3 to 9 years. Ninety-five (21.5%) of 442 ovarian cancers were associated with ovarian EM; 55 with typical EM and 40 with AEM. Clear cell and endometrioid carcinomas were most frequently associated with EM, with 40.2 % (41 of 102 cases) and 30.9% (21 of 68), respectively. AEM was fund in 20 clear cell carcinomas, in 12 endometrioid carcinomas, four serous carcinomas, three mucinous borderline tumors (Mullerian type) and one serous borderline tumor. In 16 cases, AEM was contiguous with carcinomas. Epithelial metaplasia, including eosinophilic, ciliated and mucinous metaplasia, was more often observed in AEM (47 of 47) than in ME (421 of 622).
Conclusions: Although ovarian AEM without neoplasms is a rare phenomenon, AEM possesses a precancerous potential and is most frequently associated with clear cell and endometrioid carcinomas. Epithelial metaplastic changes are also associated with AEM. Close screening of cellular atypia, hyperplasia, or epithelial metaplasia in ovarian EM is required. It is proposed that a diagnosis of AEM be followed by careful long-term observations of the patient to detect possible concurrent or subsequent development of neoplasia in the ovary or extra-ovarian sites.
Category: Gynecologic & Obstetrics
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 143, Tuesday Afternoon